Provider Demographics
NPI:1760094890
Name:COOKS, LINDA JOYCE
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOYCE
Last Name:COOKS
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 1:1903 DREW DR NW APT 1204
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3527
Mailing Address - Country:US
Mailing Address - Phone:404-245-0497
Mailing Address - Fax:404-521-4903
Practice Address - Street 1:1903 DREW DR NW APT 1204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3527
Practice Address - Country:US
Practice Address - Phone:404-245-0497
Practice Address - Fax:404-521-4903
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010378390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program