Healthcare Provider Details

I. General information

NPI: 1437804283
Provider Name (Legal Business Name): GABRIELLE CHRISTINA COTTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 WILL SCARLET WAY
MACON GA
31220-2733
US

IV. Provider business mailing address

837 WILL SCARLET WAY
MACON GA
31220-2733
US

V. Phone/Fax

Practice location:
  • Phone: 937-509-8055
  • Fax:
Mailing address:
  • Phone: 937-509-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN259563
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN259563
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN259563
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN259563
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: