Provider Demographics
NPI:1972583961
Name:COCHRAN, JULIA (PHD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-0373
Mailing Address - Country:US
Mailing Address - Phone:912-772-3072
Mailing Address - Fax:866-878-3813
Practice Address - Street 1:207 S COLUMBIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9027
Practice Address - Country:US
Practice Address - Phone:912-772-3072
Practice Address - Fax:866-878-3813
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106432AMedicaid