Provider Demographics
NPI:1760567861
Name:COOK, ROBERT G (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:COOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 EAST COY SMITH HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:36560
Mailing Address - Country:US
Mailing Address - Phone:251-662-6700
Mailing Address - Fax:251-829-5385
Practice Address - Street 1:725 EAST COY SMITH HIGHWAY
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:AL
Practice Address - Zip Code:36560
Practice Address - Country:US
Practice Address - Phone:251-662-6700
Practice Address - Fax:251-829-5385
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554523C00Medicare ID - Type Unspecified
R62086Medicare UPIN