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NPI Code Detail

MEDICARE: RANDOLPH D COOKE PH.D.

MEDICARE: RANDOLPH D COOKE PH.D.
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
1103TC0700XClinical Psychologist3124AZ

General Provider Information

NPI Number : 1861475899
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH D COOKE PH.D.
Provider Business Mailing Address
First Line : 300 HOSPITAL ROAD
Second Line : FAMILY MEDICINE CLINIC
City : FT GORDON
State : GA
Zip : 30905-5650
Country : US
Telephone Number : 706-787-0232
Fax Number :
Provider Business Practice Location Address
First Line : 300 HOSPITAL RD
Second Line : FAMILY MEDICINE CLINIC
City : FT. GORDON
State : GA
Zip : 30905
Country : US
Telephone Number : 706-787-9352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 10/08/2013

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