Healthcare Provider Details

I. General information

NPI: 1043898604
Provider Name (Legal Business Name): CODY GARRETT MCCOY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 12/08/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 3500
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

242 CARDINAL EST
PRESTONSBURG KY
41653-9096
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone: 606-226-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A22577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: