Provider Demographics
NPI:1760155725
Name:COOK, MARY BRIANNA (IBCLC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BRIANNA
Last Name:COOK
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BRIANNA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2918 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8724
Mailing Address - Country:US
Mailing Address - Phone:706-529-4600
Mailing Address - Fax:706-529-4633
Practice Address - Street 1:2918 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8724
Practice Address - Country:US
Practice Address - Phone:706-529-4600
Practice Address - Fax:706-529-4633
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-303168174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN