Healthcare Provider Details

I. General information

NPI: 1366472391
Provider Name (Legal Business Name): ANGELA COTTON, B.C.O. & ASSOC., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MEDLOCK RD
DECATUR GA
30030-1513
US

IV. Provider business mailing address

505 MEDLOCK RD
DECATUR GA
30030-1513
US

V. Phone/Fax

Practice location:
  • Phone: 404-377-0592
  • Fax: 404-377-0081
Mailing address:
  • Phone: 404-377-0592
  • Fax: 404-377-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK W MILLER III
Title or Position: BUSINESS MANAGER/OWNER
Credential:
Phone: 404-377-0592