Healthcare Provider Details

I. General information

NPI: 1275150294
Provider Name (Legal Business Name): JAMES PATRICK COOK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 TELFAIR ST FL 3
AUGUSTA GA
30901-2590
US

IV. Provider business mailing address

PO BOX 2344
AUGUSTA GA
30903-2344
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0601
  • Fax: 706-849-4195
Mailing address:
  • Phone: 706-922-0601
  • Fax: 706-849-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN016067
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: