Provider Demographics
NPI:1295166056
Name:COCHRAN, THOMAS CHADWICK (RD, LD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHADWICK
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MEADVILLE STREET
Mailing Address - Street 2:PO BOX 1082
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-1082
Mailing Address - Country:US
Mailing Address - Phone:601-341-0398
Mailing Address - Fax:
Practice Address - Street 1:1011 MEADVILLE STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-341-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1406133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered