Healthcare Provider Details

I. General information

NPI: 1902614118
Provider Name (Legal Business Name): SARA RACHEL COOK APC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 CLAIRMONT RD STE 102
DECATUR GA
30030-1250
US

IV. Provider business mailing address

1110 BALLPARK LN APT 1207
LAWRENCEVILLE GA
30043-2183
US

V. Phone/Fax

Practice location:
  • Phone: 770-750-4001
  • Fax:
Mailing address:
  • Phone: 706-764-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC009981
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: