Healthcare Provider Details

I. General information

NPI: 1427456276
Provider Name (Legal Business Name): MR. JAMES CHANDLER COGGINS II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N STE 101
JACKSONVILLE FL
32216-8005
US

IV. Provider business mailing address

6867 SOUTHPOINT DR N STE 101
JACKSONVILLE FL
32216-8005
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-6071
  • Fax:
Mailing address:
  • Phone: 904-619-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: