Provider Demographics
NPI:1184658924
Name:COTNEY, MARK EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:COTNEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3554
Mailing Address - Country:US
Mailing Address - Phone:706-646-2225
Mailing Address - Fax:706-648-2153
Practice Address - Street 1:101 N GREEN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3554
Practice Address - Country:US
Practice Address - Phone:706-646-2225
Practice Address - Fax:706-648-2153
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00297184AMedicaid
GA00297184AMedicaid