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
Fax: (478) 254-4924
Website:

Health care specialties

SpecialtyCodeLicense #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 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548265549 NPPES
Georgia MEDICAID 100002802A
Georgia MEDICAID 100002802B
Georgia MEDICAID 00317358L

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