Provider Demographics
NPI:1669625000
Name:WILLIAM S COOK JR M D P A
Entity type:Organization
Organization Name:WILLIAM S COOK JR M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-366-3660
Mailing Address - Street 1:2906 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4233
Mailing Address - Country:US
Mailing Address - Phone:601-366-3660
Mailing Address - Fax:
Practice Address - Street 1:2906 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4233
Practice Address - Country:US
Practice Address - Phone:601-366-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty