MEDICARE: TIMOTHY COOKE

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
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1881022770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY COOKE

Provider Business Mailing Address
First Line	:	2250 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3192
Country	:	US
Telephone Number	:	770-843-3164
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3192
Country	:	US
Telephone Number	:	770-843-3164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2013
Last Update Date	:	10/31/2013

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Directions to “ TIMOTHY COOKE ” Practice Location

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