Basic Information
| Provider Information | |||||||||
| NPI: | 1376789628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOPE COTTAGE FAMILY HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 BRECKINRIDGE BLVD STE 120 | ||||||||
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| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782260082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 N CUTHBERT ST | ||||||||
| Address2: | |||||||||
| City: | COLQUITT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398373518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2297269900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2008 | ||||||||
| LastUpdateDate: | 12/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | GORDON | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2297269900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1053165 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.