Provider Demographics
NPI:1952414492
Name:COOK, CATHY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:L
Last Name:COOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 WARM SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6858
Mailing Address - Country:US
Mailing Address - Phone:706-689-2905
Mailing Address - Fax:706-689-7490
Practice Address - Street 1:2751 WARM SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6858
Practice Address - Country:US
Practice Address - Phone:706-689-2905
Practice Address - Fax:706-689-7490
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102653460CMedicaid