Healthcare Provider Details

I. General information

NPI: 1447326913
Provider Name (Legal Business Name): LOUIS D COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30045-7694
US

IV. Provider business mailing address

4520 RIVER MANSIONS TRCE
BERKELEY LAKE GA
30096-2996
US

V. Phone/Fax

Practice location:
  • Phone: 678-442-3317
  • Fax: 678-442-4416
Mailing address:
  • Phone: 770-448-0918
  • Fax: 770-448-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number027787
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: