Provider Demographics
NPI:1124503933
Name:ROOK, ALEXIS NOELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NOELLE
Last Name:ROOK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2784
Mailing Address - Country:US
Mailing Address - Phone:770-312-1835
Mailing Address - Fax:
Practice Address - Street 1:1825 HIGHWAY 34 E STE 1200
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6416
Practice Address - Country:US
Practice Address - Phone:770-502-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8890OtherGA STATE LICENSE