Provider Demographics
NPI:1285820936
Name:COOKE, JUSTIN T (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:T
Last Name:COOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3477 LOWERY PKWY STE 137
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-1687
Mailing Address - Country:US
Mailing Address - Phone:205-379-6040
Mailing Address - Fax:205-379-6039
Practice Address - Street 1:3477 LOWERY PKWY STE 137
Practice Address - Street 2:
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068
Practice Address - Country:US
Practice Address - Phone:205-379-6040
Practice Address - Fax:205-379-6039
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN46351207Q00000X
ALMD.35125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I080265Medicare PIN