Healthcare Provider Details

I. General information

NPI: 1730100090
Provider Name (Legal Business Name): MARY FRANCES COOK PT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 DEKALB AVE NE SUITE C
ATLANTA GA
30307-2176
US

IV. Provider business mailing address

PO BOX 5492
ATLANTA GA
31107
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-7160
  • Fax: 404-996-2605
Mailing address:
  • Phone: 404-444-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 117
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 7706
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: