Healthcare Provider Details

I. General information

NPI: 1629574827
Provider Name (Legal Business Name): STEPHANIE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

200 SCARLET WAY
LEESBURG GA
31763-5996
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-2052
  • Fax:
Mailing address:
  • Phone: 229-854-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN117724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: