Provider Demographics
NPI:1861727505
Name:COOK, MELANIE (MED)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 KATHERINE CT
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-5276
Mailing Address - Country:US
Mailing Address - Phone:770-883-0696
Mailing Address - Fax:
Practice Address - Street 1:261 KATHERINE CT
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-5276
Practice Address - Country:US
Practice Address - Phone:770-883-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist