Provider Demographics
NPI:1619593159
Name:COOK-FORD, SYNTHEL LORRAINE
Entity Type:Individual
Prefix:
First Name:SYNTHEL
Middle Name:LORRAINE
Last Name:COOK-FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 BRUSHY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-5606
Mailing Address - Country:US
Mailing Address - Phone:910-286-6061
Mailing Address - Fax:
Practice Address - Street 1:2187 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0264
Practice Address - Country:US
Practice Address - Phone:910-364-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier