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Individual

KOESHA TIERRA COOK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1700 MULKEY RD, AUSTELL, GA 30106-1116
(770) 941-5750
Mailing address
1325 WINDY RIDGE LN SE, ATLANTA, GA 30339-2446
(404) 951-6445

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA002616
GA

Other

Enumeration date
07/27/2014
Last updated
07/27/2014
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