Healthcare Provider Details

I. General information

NPI: 1609860014
Provider Name (Legal Business Name): HEATHER TOMLINSON COGGINS MPA, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 VERNON RD
LAGRANGE GA
30240-4131
US

IV. Provider business mailing address

1268 COUNTY ROAD 393
LANETT AL
36863-5379
US

V. Phone/Fax

Practice location:
  • Phone: 706-812-2499
  • Fax:
Mailing address:
  • Phone: 706-333-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD001575
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: