Provider Demographics
NPI:1700076031
Name:MCCREARY, CODY S (HIS)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:S
Last Name:MCCREARY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3268 US HIGHWAY 441 S
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-6239
Mailing Address - Country:US
Mailing Address - Phone:863-763-9700
Mailing Address - Fax:863-763-9705
Practice Address - Street 1:1200 ERNEST W BARRETT PKWY NW
Practice Address - Street 2:#12
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7557
Practice Address - Country:US
Practice Address - Phone:770-919-8324
Practice Address - Fax:770-919-8943
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHAP000069390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program