Healthcare Provider Details

I. General information

NPI: 1669438958
Provider Name (Legal Business Name): DONNA LOUISE COTHRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY NICU UNIVERSITY HOSPITAL
AUGUSTA GA
30901-2629
US

IV. Provider business mailing address

1350 WALTON WAY NICU UNIVERSITY HOSPITAL
AUGUSTA GA
30901-2629
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-2791
  • Fax: 706-774-8712
Mailing address:
  • Phone: 706-724-2791
  • Fax: 706-774-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101048203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: