Provider Demographics
NPI:1467753756
Name:TIMOTHY A COOK SERVICES,LLC
Entity Type:Organization
Organization Name:TIMOTHY A COOK SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:706-650-1056
Mailing Address - Street 1:326 DUNGANNON DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-4507
Mailing Address - Country:US
Mailing Address - Phone:706-650-1056
Mailing Address - Fax:706-650-1056
Practice Address - Street 1:326 DUNGANNON DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-4507
Practice Address - Country:US
Practice Address - Phone:706-650-1056
Practice Address - Fax:706-650-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty