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NPI Code Detail

MEDICARE: LILY COOK

MEDICARE: LILY COOK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-22-205962SC

General Provider Information

NPI Number : 1275280570
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILY COOK
Provider Business Mailing Address
First Line : 3736 EXECUTIVE CENTER DR
Second Line :
City : AUGUSTA
State : GA
Zip : 30907-2360
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 830 GRACERN RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29210-7629
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2022
Last Update Date : 03/07/2022

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Directions to “ LILY COOK ” Practice Location

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