Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 14609 | GA |
NPI | 1609822915 |
---|---|
Provider Name | Dr. Terrence J Cook |
First Address | Augusta, GA 30904-4128 |
Second Address | Augusta, GA 30904-4128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 21/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00013024 | (05) | GA |
282346 | BCBS GA (01) | GA |
D39636 | (02) | GA |