Healthcare Provider Details

I. General information

NPI: 1114903689
Provider Name (Legal Business Name): AMY H COCHRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 JESSE JEWELL PKWY NE SUITE 200
GAINESVILLE GA
30501-3801
US

IV. Provider business mailing address

1485 JESSE JEWELL PKWY NE SUITE 200
GAINESVILLE GA
30501-3801
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-5255
  • Fax: 770-287-3871
Mailing address:
  • Phone: 770-534-5255
  • Fax: 770-287-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38518
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: