Provider Demographics
NPI:1063407831
Name:COGGINS, JOHN ROBERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:COGGINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1551 DOCTORS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-803-7450
Mailing Address - Fax:770-999-2818
Practice Address - Street 1:1551 DOCTORS DRIVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-803-7450
Practice Address - Fax:770-999-2818
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033949174400000X
GA33949207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD83700Medicare UPIN
GA10BBBDXMedicare PIN