Provider Demographics
NPI:1134909351
Name:COOK, DANIELLE SAMONE KEMBA (CPS, WHAM, CAT, CDDC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SAMONE KEMBA
Last Name:COOK
Suffix:
Gender:F
Credentials:CPS, WHAM, CAT, CDDC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:KEMBA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2785 LAWRENCEVILLE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2515
Mailing Address - Country:US
Mailing Address - Phone:470-363-7900
Mailing Address - Fax:
Practice Address - Street 1:2785 LAWRENCEVILLE HWY STE 205
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2515
Practice Address - Country:US
Practice Address - Phone:470-363-7900
Practice Address - Fax:404-371-8928
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00000000175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist