Healthcare Provider Details

I. General information

NPI: 1215926316
Provider Name (Legal Business Name): ROCHELLE COTLIAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LACY ST NW SUITE 150
MARIETTA GA
30060-1113
US

IV. Provider business mailing address

100 LACY ST NW SUITE 150
MARIETTA GA
30060-1113
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-7635
  • Fax: 770-793-7645
Mailing address:
  • Phone: 770-793-7635
  • Fax: 770-793-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number038454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: