Provider Demographics
NPI:1700124880
Name:COTTON, GENE R (RPH)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:R
Last Name:COTTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HIGHWAY 334
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30530-4835
Mailing Address - Country:US
Mailing Address - Phone:706-335-4650
Mailing Address - Fax:706-335-5305
Practice Address - Street 1:220 HWY 334
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529
Practice Address - Country:US
Practice Address - Phone:706-335-4650
Practice Address - Fax:706-335-5305
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist