Provider Demographics
NPI:1316123557
Name:COTO-PUCKETT, WENDY LYNN (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:COTO-PUCKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDEY
Other - Middle Name:LYNN
Other - Last Name:COTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-535-3611
Practice Address - Fax:770-535-7092
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059908208000000X, 2080N0001X
CAA108494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA712419OtherWELLCARE HEALTH PLANS
GA52597492OtherBCBS OF GEORGIA
GA01674418OtherAMERIGROUP