Provider Demographics
NPI:1467443713
Name:COOK, JONATHAN M (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:COOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR STE 400A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:063-537-7477
Mailing Address - Fax:706-353-7756
Practice Address - Street 1:700 SUNSET DR STE 400A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-353-7747
Practice Address - Fax:706-353-7756
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042549207P00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBQPWMedicare ID - Type UnspecifiedMEDICARE ID
F83673Medicare UPIN
GA169764070AMedicare ID - Type UnspecifiedMEDICAID ID