Provider Demographics
NPI:1740495639
Name:COCKRELL, JOSEPH ROBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:COCKRELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:NAVAL HEALTH CLINIC CHARLESTON
Mailing Address - Street 2:110 NNPTC CIRCLE
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445
Mailing Address - Country:US
Mailing Address - Phone:843-794-6450
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC CHARLESTON
Practice Address - Street 2:110 NNPTC CIRCLE
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445
Practice Address - Country:US
Practice Address - Phone:843-794-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC147512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry