Healthcare Provider Details

I. General information

NPI: 1366527558
Provider Name (Legal Business Name): AMANDA H. COOK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY HOUPT COOK

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 LAYFAIR DRIVE
FLOWOOD MS
39232
US

IV. Provider business mailing address

P.O. BOX 321434
FLOWOOD MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-420-8233
  • Fax: 601-936-5370
Mailing address:
  • Phone: 601-420-8233
  • Fax: 601-936-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19278
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: