Healthcare Provider Details

I. General information

NPI: 1851520258
Provider Name (Legal Business Name): NICOLE ANN COTHRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ANN THOMAS M.D.

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE ROAD
GREENVILLE SC
29605-5601
US

IV. Provider business mailing address

701 GROVE ROAD
GREENVILLE SC
29605-5601
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7165
  • Fax: 864-455-3685
Mailing address:
  • Phone: 864-455-7165
  • Fax: 864-455-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number38152
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: