Provider Demographics
NPI:1528021722
Name:COOK, NELSON W (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:W
Last Name:COOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5754
Mailing Address - Country:US
Mailing Address - Phone:256-237-8527
Mailing Address - Fax:256-237-0208
Practice Address - Street 1:400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5754
Practice Address - Country:US
Practice Address - Phone:256-237-8527
Practice Address - Fax:256-237-0208
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000018560Medicare PIN
ALC72122Medicare UPIN