Healthcare Provider Details

I. General information

NPI: 1740647312
Provider Name (Legal Business Name): CHRISTOPHER COTTLE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TOWER RD NE SUITE 300
MARIETTA GA
30060-9408
US

IV. Provider business mailing address

42 BRECKENRIDGE DR
CEDARTOWN GA
30125-6046
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-2457
  • Fax: 770-427-2706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN216126
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: