Cogburn, Rallie D
Cogburn, Rallie D is an sole proprietor health care provider with primary practice located at 6070 Lakeside Commons Dr , Macon GA 31210-5778. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Cogburn, Rallie D can be contacted via phone (478) 254-2644.Contact Information
Primary practice address
6070 Lakeside Commons Dr
Macon GA 31210-5778
Phone: (478) 254-2644
Fax: (478) 254-4924
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 003476 | Georgia |
Profile Details
| NPI number | 1548265549 |
|---|---|
| LBN Legal business name | Cogburn, Rallie D |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Oct 3rd, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548265549 | NPPES |
| Georgia | MEDICAID | 100002802A | |
| Georgia | MEDICAID | 100002802B | |
| Georgia | MEDICAID | 00317358L |
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