Provider Demographics
NPI:1841399953
Name:COTTER, DAVID M (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:COTTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 AMBERLEIGH DR SE
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-3547
Mailing Address - Country:US
Mailing Address - Phone:678-977-7538
Mailing Address - Fax:
Practice Address - Street 1:103 AMBERLEIGH DR SE
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:GA
Practice Address - Zip Code:30184-3547
Practice Address - Country:US
Practice Address - Phone:678-977-7538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0040369207P00000X
GA4036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I970319OtherMEDICARE PTAN