Provider Demographics
NPI:1568547941
Name:COLONY DENTAL CARE
Entity Type:Organization
Organization Name:COLONY DENTAL CARE
Other - Org Name:COLONY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HANKIN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-423-4500
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-0548
Mailing Address - Country:US
Mailing Address - Phone:229-423-4500
Mailing Address - Fax:229-423-3562
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-2945
Practice Address - Country:US
Practice Address - Phone:229-423-4500
Practice Address - Fax:229-423-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty