Healthcare Provider Details

I. General information

NPI: 1881786267
Provider Name (Legal Business Name): CAREY GORDON COTTLE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DOLLEY MADISON RD STE 410
GREENSBORO NC
27410-5167
US

IV. Provider business mailing address

445 DOLLEY MADISON RD STE 410
GREENSBORO NC
27410-5167
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-1510
  • Fax: 336-292-0679
Mailing address:
  • Phone: 336-292-1510
  • Fax: 336-292-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39167MEDICAL
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: