Healthcare Provider Details

I. General information

NPI: 1063407831
Provider Name (Legal Business Name): JOHN ROBERT COGGINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 04/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 DOCTORS DRIVE
LAGRANGE GA
30240
US

IV. Provider business mailing address

1551 DOCTORS DRIVE
LAGRANGE GA
30240
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-7450
  • Fax: 770-999-2818
Mailing address:
  • Phone: 706-803-7450
  • Fax: 770-999-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number033949
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number33949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: