Healthcare Provider Details

I. General information

NPI: 1043944267
Provider Name (Legal Business Name): CHRISTINA COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TANZANIA TRL
POOLER GA
31322-3814
US

IV. Provider business mailing address

501 FOREST DR
STATESBORO GA
30458
US

V. Phone/Fax

Practice location:
  • Phone: 912-244-0244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: