Provider Demographics
NPI:1376998096
Name:COGA HEALTH
Entity Type:Organization
Organization Name:COGA HEALTH
Other - Org Name:COASTAL GEORGIA CHILD NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAYNARD
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-884-1137
Mailing Address - Street 1:139 ALTAMA CONNECTOR
Mailing Address - Street 2:PMB 316
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1888
Mailing Address - Country:US
Mailing Address - Phone:864-884-1137
Mailing Address - Fax:912-330-1009
Practice Address - Street 1:139 ALTAMA CONNECTOR
Practice Address - Street 2:PMB 316
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1888
Practice Address - Country:US
Practice Address - Phone:864-884-1137
Practice Address - Fax:912-330-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA755232084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty