MEDICARE: JAMES DAVID KOTICK 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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	ME121445	FL
2	2086S0127X	Trauma Surgery Physician	ME121445	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1336438704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DAVID KOTICK MD

Provider Business Mailing Address
First Line	:	PO BOX 3725
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30914-3725
Country	:	US
Telephone Number	:	706-863-9595
Fax Number	:	706-868-8375

Provider Business Practice Location Address
First Line	:	1561 LAKEFRONT DR UNIT 202
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-1637
Country	:	US
Telephone Number	:	941-822-8955
Fax Number	:	941-822-8684

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	01/06/2025

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