Provider Demographics
NPI:1558337428
Name:COOK, JENNIFER S (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:COOK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MORRISON MOORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1588
Mailing Address - Country:US
Mailing Address - Phone:706-864-3323
Mailing Address - Fax:706-864-4484
Practice Address - Street 1:95 MORRISON MOORE PKWY W
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1588
Practice Address - Country:US
Practice Address - Phone:706-864-3323
Practice Address - Fax:706-864-4484
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA128463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000909268BMedicaid
GAP24421Medicare UPIN
GA000909268BMedicaid