Provider Demographics
NPI:1598753154
Name:COCHRAN, WILLIE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:
Last Name:COCHRAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4107
Mailing Address - Country:US
Mailing Address - Phone:770-474-7287
Mailing Address - Fax:770-389-3713
Practice Address - Street 1:4000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4107
Practice Address - Country:US
Practice Address - Phone:770-474-7287
Practice Address - Fax:770-389-3713
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035229208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BDGVZMedicare ID - Type Unspecified
GA02BDJJNMedicare PIN
GAD70784Medicare UPIN