Provider Demographics
NPI:1841286838
Name:COOK, HEWLETTE DENNIS
Entity type:Individual
Prefix:MR
First Name:HEWLETTE
Middle Name:DENNIS
Last Name:COOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8136
Mailing Address - Country:US
Mailing Address - Phone:706-278-2824
Mailing Address - Fax:
Practice Address - Street 1:1100 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3016
Practice Address - Country:US
Practice Address - Phone:706-278-2490
Practice Address - Fax:706-272-3056
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist