Provider Demographics
NPI:1477306850
Name:COCHRAN, PATRICK HEZEKIAH
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:HEZEKIAH
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 DEER WOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-9194
Mailing Address - Country:US
Mailing Address - Phone:404-372-4801
Mailing Address - Fax:
Practice Address - Street 1:650 SCRANTON RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1927
Practice Address - Country:US
Practice Address - Phone:912-289-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist