Provider Demographics
NPI:1023168275
Name:EDUARDO M COSSIO MDPC
Entity type:Organization
Organization Name:EDUARDO M COSSIO MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:COSSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-342-0449
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-0879
Mailing Address - Country:US
Mailing Address - Phone:706-342-0449
Mailing Address - Fax:706-342-8332
Practice Address - Street 1:1075 S MAIN ST
Practice Address - Street 2:STE 300
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2074
Practice Address - Country:US
Practice Address - Phone:706-342-0449
Practice Address - Fax:706-342-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000406898AMedicaid
GA11BDBNKMedicare PIN
GAE30751Medicare UPIN