Provider Demographics
NPI:1689878084
Name:COOLS, KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:COOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4353
Mailing Address - Country:US
Mailing Address - Phone:912-877-2228
Mailing Address - Fax:912-877-2463
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4353
Practice Address - Country:US
Practice Address - Phone:912-877-2228
Practice Address - Fax:912-877-2463
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141067207V00000X
GA066770207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA066770OtherGA LICENSE NUMBER
NC141067OtherLICENSE NUMBER
GAFC2835669OtherDEA REGISTRATION NUMBER