Healthcare Provider Details

I. General information

NPI: 1770597304
Provider Name (Legal Business Name): COOK MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CARTER ST
RICHMOND HILL GA
31324-3753
US

IV. Provider business mailing address

PO BOX 790
RICHMOND HILL GA
31324-0790
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-6131
  • Fax: 912-756-6540
Mailing address:
  • Phone: 912-756-6130
  • Fax: 912-756-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-015-1678
License Number StateGA

VIII. Authorized Official

Name: TERRY COOK
Title or Position: COO
Credential:
Phone: 404-641-1919