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General NPI Number Information
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NPI Number | 1396079737
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Entity Type | Organization
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Legal Business Name | CARLOS COSSIO MD PC
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 10/01/2009
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Provider Practice Location Address
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Address Line | 1077 BAXTER ST SUITE K
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City | ATHENS
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State | GA
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Zip | 30606-3767
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Country | US
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Telephone | 706-613-0313
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Fax | 706-613-0229
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Provider Business Mailing Address
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Address Line | 1077 BAXTER ST SUITE K
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City | ATHENS
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State | GA
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Zip | 30606-3767
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Country | US
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Telephone | 706-613-0313
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Fax | 706-613-0229
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/PHYSICIAN
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Name | CARLOS COSSIO
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Credential | MD
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Telephone | 716-613-0313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 036127
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036127
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036127
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License Number State | GA
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