MEDICARE: DR. J. KENNETH COOK, PC

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	111N00000X	Chiropractor	CHIR007190	GA
2	111N00000X	Chiropractor	CHIR009579	GA
3	111N00000X	Chiropractor	CHIR005040	GA

General Provider Information

NPI Number	:	1962947143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. J. KENNETH COOK, PC

Provider Business Mailing Address
First Line	:	1050 BARBER CREEK DR STE 200
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-4502
Country	:	US
Telephone Number	:	706-548-8984
Fax Number	:	706-383-7781

Provider Business Practice Location Address
First Line	:	1050 BARBER CREEK DR STE 200
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-4502
Country	:	US
Telephone Number	:	706-548-8984
Fax Number	:	706-383-7781

Authorized Official
Title or Position	:	OWNER
Name	:	J. KENNETH COOK
Credential	:
Telephone Number	:	404-915-5445

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	01/12/2026

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