Provider Demographics
NPI:1699926311
Name:COLE, RECO T SR
Entity type:Individual
Prefix:MR
First Name:RECO
Middle Name:T
Last Name:COLE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 HERITAGE VLG
Mailing Address - Street 2:SUITE 16-238
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6140
Mailing Address - Country:US
Mailing Address - Phone:404-933-1632
Mailing Address - Fax:888-623-3021
Practice Address - Street 1:2483 HERITAGE VLG
Practice Address - Street 2:SUITE 16-238
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6140
Practice Address - Country:US
Practice Address - Phone:404-933-1632
Practice Address - Fax:888-623-3021
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055069601172A00000X
171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171WV0202XOther Service ProvidersContractorVehicle Modifications