Healthcare Provider Details

I. General information

NPI: 1841233970
Provider Name (Legal Business Name): COOK MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 INDUSTRIAL BLVD
DUBLIN GA
31021-2800
US

IV. Provider business mailing address

PO BOX 1243
DUBLIN GA
31040-1243
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-7437
  • Fax: 478-272-2427
Mailing address:
  • Phone: 478-272-7437
  • Fax: 478-272-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-087-1943
License Number StateGA

VIII. Authorized Official

Name: TERRELL B COOK JR.
Title or Position: COO
Credential:
Phone: 229-868-7406