Provider Demographics
NPI:1760523948
Name:COX, KATHERINE DIANNE (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DIANNE
Last Name:COX
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4046
Mailing Address - Country:US
Mailing Address - Phone:706-866-2111
Mailing Address - Fax:706-866-5363
Practice Address - Street 1:1670 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4046
Practice Address - Country:US
Practice Address - Phone:706-866-2111
Practice Address - Fax:706-866-5363
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1119T152W00000X
TN920T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0116122OtherBLUECROSSBLUESHIELD
GA0845880002OtherDMERC
GA004463555AMedicaid
GA0845880002OtherDMERC
GA004463555AMedicaid