Provider Demographics
NPI:1649492844
Name:COOL, AMY E (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:COOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2001 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4572
Mailing Address - Country:US
Mailing Address - Phone:706-571-9699
Mailing Address - Fax:706-571-9565
Practice Address - Street 1:2001 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4572
Practice Address - Country:US
Practice Address - Phone:706-571-9699
Practice Address - Fax:706-571-9565
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116017660390200000X
VA0101243753208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649492844Medicaid