Melissa Shunta Cooper, CMA

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

20268794737 Issued in GA

Practice address

4600 Farmington Rd
Watkinsville, GA 30677-4374

Phone

(706) 340-9566

NPI assigned

Oct 11, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Medical Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Mobile Phlebotomist of Georgia

  • Phlebology Physician
  • Watkinsville, GA
  • NPI 1780340521
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1669134300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 FARMINGTON RD",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774374",
            "telephone_number": "706-340-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 FARMINGTON RD",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774374",
            "telephone_number": "706-340-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOPER",
        "first_name": "MELISSA",
        "middle_name": "SHUNTA",
        "credential": "CMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "GA",
            "license": "20268794737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ELITE MOBILE PHLEBOTOMIST OF GA. LLC",
            "identifier": "87-1622293",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.https/elitemobilephlebotomistofga.com",
            "affiliation": "Y",
            "endpointDescription": "business URL",
            "affiliationName": "Ulta lab tests",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4600 Farmington Rd",
            "city": "Watkinsville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306774374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Conyers Regenerative and Joint Institute LLC
• J. Kenneth Cook, D.C.
• Jessica Hope Cook, PA-C
• Alexus Paige Cooper
• Cynthia Cooper, RBT
• Courtney Corbett
• Hiram Correa, RBT
• Counseling, Mindfulness, & Recovery LLC
• Kacie Coursey
• Rachel Anne Cowart, CCC-SLP

• Phlebology Physician in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Phlebology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.