Provider Demographics
NPI:1962579268
Name:JAY S COCHRAN MD PC
Entity type:Organization
Organization Name:JAY S COCHRAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-896-0544
Mailing Address - Street 1:2000 US HIGHWAY 76 WEST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546
Mailing Address - Country:US
Mailing Address - Phone:706-896-0544
Mailing Address - Fax:706-896-7282
Practice Address - Street 1:2000 US HIGHWAY 76 WEST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546
Practice Address - Country:US
Practice Address - Phone:706-896-0544
Practice Address - Fax:706-896-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52235849208D00000X
GARN053003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
52235849OtherBCBS
NC890533EMedicaid
GA00325234HMedicaid
GA01BDHKVMedicare ID - Type Unspecified
GA00325234HMedicaid
NC890533EMedicaid
D39615Medicare UPIN