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General NPI Number Information
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NPI Number | 1386794113
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Entity Type | Individual
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Provider Name | CHARLES ADAM DECOOK MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2000 HOWARD FARM DR STE 200
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City | CUMMING
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State | GA
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Zip | 30041-6081
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Country | US
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Telephone | 770-292-6500
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Fax | 770-292-6535
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Provider Business Mailing Address
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Address Line | 2000 HOWARD FARM DR STE 200
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City | CUMMING
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State | GA
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Zip | 30041-6081
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Country | US
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Telephone | 770-292-6500
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Fax | 770-292-6535
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200301449
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101245422
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 63576
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License Number State | GA
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