=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497553952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN ELIZABETH BROWN-COTTOM LDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1260 MARS HILL RD STE 103
-----------------------------------------------------
City | WATKINSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30677-4943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-705-1613
-----------------------------------------------------
Fax | 762-310-0055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1260 MARS HILL RD STE 103
-----------------------------------------------------
City | WATKINSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30677-4943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-705-1613
-----------------------------------------------------
Fax | 762-310-0055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | LDO002711
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------