Provider Demographics
NPI:1043710916
Name:DRAUGHN COGGINS & MOORE CONSULTANT, LLC
Entity Type:Organization
Organization Name:DRAUGHN COGGINS & MOORE CONSULTANT, LLC
Other - Org Name:COLLABORATIVE CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,
Authorized Official - Phone:863-333-1018
Mailing Address - Street 1:2150 MORGAN WIELAND LN APT 108
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3189
Mailing Address - Country:US
Mailing Address - Phone:863-852-6760
Mailing Address - Fax:863-209-7991
Practice Address - Street 1:2150 MORGAN WIELAND LN APT 108
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3189
Practice Address - Country:US
Practice Address - Phone:863-852-6760
Practice Address - Fax:863-209-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME218582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty