Provider Demographics
NPI:1255327052
Name:COOK, ROBERT TED (MD MPH FAAFP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:TED
Last Name:COOK
Suffix:
Gender:M
Credentials:MD MPH FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-0430
Mailing Address - Country:US
Mailing Address - Phone:706-695-4546
Mailing Address - Fax:706-695-0231
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2058
Practice Address - Country:US
Practice Address - Phone:706-695-4546
Practice Address - Fax:706-695-0231
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA026087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00289913AMedicaid
GA00289913AMedicaid