Provider Demographics
NPI:1437629821
Name:COOK, LOUNDON DAVID
Entity Type:Individual
Prefix:
First Name:LOUNDON
Middle Name:DAVID
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 KOWEETA TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1638
Mailing Address - Country:US
Mailing Address - Phone:386-986-8875
Mailing Address - Fax:
Practice Address - Street 1:595 KOWEETA TRL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-1638
Practice Address - Country:US
Practice Address - Phone:386-986-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies