Individual
KEVIN DWAYNE COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPS
Contact information
Practice address
1621 LINE CIR, #2, DECATUR, GA 30032-3336
(404) 838-9936
Mailing address
1621 LINE CIR, #2, DECATUR, GA 30032-3336
(404) 838-9936
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
GA
Other
Enumeration date
08/11/2013
Last updated
08/11/2013
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