Provider Demographics
NPI:1881654853
Name:COCHRAN, KEVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:COCHRAN
Suffix:
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 1:1207 WEST MEDICAL PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4504
Mailing Address - Country:US
Mailing Address - Phone:706-854-1511
Mailing Address - Fax:706-854-0542
Practice Address - Street 1:1207 WEST MEDICAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4504
Practice Address - Country:US
Practice Address - Phone:706-854-1511
Practice Address - Fax:706-854-0542
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033948174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000448841CMedicaid
SCGPA621Medicaid
GA345823OtherWELLCARE
GAE83755Medicare UPIN
GA02BDGXRMedicare ID - Type Unspecified
GA000448841CMedicaid