Provider Demographics
NPI:1376167163
Name:COOK, SHATANYA MONIQUE (NP)
Entity Type:Individual
Prefix:
First Name:SHATANYA
Middle Name:MONIQUE
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1800 PEACHTREE ST NW STE 750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2530
Mailing Address - Country:US
Mailing Address - Phone:404-351-7654
Mailing Address - Fax:404-609-7605
Practice Address - Street 1:1233 HIGHWAY 54 W STE 205
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4542
Practice Address - Country:US
Practice Address - Phone:404-351-7654
Practice Address - Fax:404-609-7605
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN245927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily