Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN016067 | GA |
NPI | 1275150294 |
---|---|
Provider Name | James Patrick Cook |
First Address | Augusta, GA 30903-2344 |
Second Address | Augusta, GA 30901-2590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2020 |
Last Update Date | 26/06/2020 |