Healthcare Provider Details

I. General information

NPI: 1750990529
Provider Name (Legal Business Name): HALEY EMMARY COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 QUILLIAN ST
CLEVELAND GA
30528-1464
US

IV. Provider business mailing address

273 QUILLIAN ST
CLEVELAND GA
30528-1464
US

V. Phone/Fax

Practice location:
  • Phone: 706-865-6800
  • Fax:
Mailing address:
  • Phone: 706-865-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET003174
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: