Provider Demographics
NPI:1386794113
Name:DECOOK, CHARLES ADAM (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ADAM
Last Name:DECOOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HOWARD FARM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6081
Mailing Address - Country:US
Mailing Address - Phone:770-292-6500
Mailing Address - Fax:770-292-6535
Practice Address - Street 1:2000 HOWARD FARM DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6081
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301449207Q00000X
VA0101245422207X00000X
GA63576207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA509140519CMedicaid
GA557507OtherWELLCARE
NC89136RRMedicaid
GA9485152OtherAETNA
VA0101245422OtherLICENSE
GA509140519AMedicaid
GAP01659745OtherRR MEDICARE
GA509140519OMedicaid
GA52241691OtherBCBS
GA7493615OtherCIGNA
GAP00903599OtherMEDICARE RAILROAD
GA01353242OtherAMERIGROUP
GA509140519QMedicaid
GA509140519BMedicaid
GA509140519PMedicaid
GAP01726634OtherRR MEDICARE
GAP01726634OtherRR MEDICARE
GA7493615OtherCIGNA
GA557507OtherWELLCARE
GA202I209711Medicare PIN