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NPI Code Detail

MEDICARE: RODERICA E. COTTRELL MD

MEDICARE: RODERICA E. COTTRELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician054986GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336194836
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODERICA E. COTTRELL MD
Provider Business Mailing Address
First Line : 3211 IRIS DR
Second Line :
City : COVINGTON
State : GA
Zip : 30016-0907
Country : US
Telephone Number : 770-787-4042
Fax Number : 770-787-4001
Provider Business Practice Location Address
First Line : 3211 IRIS DR
Second Line :
City : COVINGTON
State : GA
Zip : 30016-0907
Country : US
Telephone Number : 770-787-4042
Fax Number : 770-787-4001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 03/27/2008

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Directions to “ RODERICA E. COTTRELL MD” Practice Location

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