Active NPI
Koesha Tierra Cook
- Contractor
- Austell, GA
National Provider Identifier
1790193381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- PTA002616
- Practice address
- 1700 Mulkey Rd
Austell, GA 30106-1116 - Phone
- (770) 941-5750
- NPI assigned
- Jul 27, 2014
- Last updated
- Jul 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | PTA002616 | GA | Primary |
Addresses
Primary practice location
1700 Mulkey Rd
Austell, GA 30106-1116
Mailing address
1325 Windy Ridge LN SE
Atlanta, GA 30339-2446
Phone (404) 951-6445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA002616 | GA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406419200000",
"number": "1790193381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 WINDY RIDGE LN SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303392446",
"telephone_number": "404-951-6445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 MULKEY RD",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061116",
"telephone_number": "770-941-5750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOK",
"first_name": "KOESHA",
"middle_name": "TIERRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-27",
"last_updated": "2014-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "GA",
"license": "PTA002616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.