Provider Demographics
NPI:1699838045
Name:COOKSEY, CRIT REON (MD)
Entity Type:Individual
Prefix:
First Name:CRIT
Middle Name:REON
Last Name:COOKSEY
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 1:3827 ROSWELL ROAD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6262
Mailing Address - Country:US
Mailing Address - Phone:678-290-3396
Mailing Address - Fax:770-579-0669
Practice Address - Street 1:3827 ROSWELL ROAD
Practice Address - Street 2:SUITE 100B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6262
Practice Address - Country:US
Practice Address - Phone:678-290-3396
Practice Address - Fax:770-579-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-06-24
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-09-05
Provider Licenses
StateLicense IDTaxonomies
GA0384522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000711829DMedicaid
GRP2111OtherGROUP MEDICARE PIN
GA000711829DMedicaid
26BDKGJMedicare PIN
GRP2111OtherGROUP MEDICARE PIN