Basic Information
| Provider Information | |||||||||
| NPI: | 1902857899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COGHILL | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | HERNDON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55823 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059962244 | ||||||||
| FaxNumber: | 2059962254 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 NHB | ||||||||
| Address2: | 619 SOUTH 19TH STREET | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352490001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059962244 | ||||||||
| FaxNumber: | 2059962254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 17155 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00114021 | 01 | MISSISSIPPI MEDICAID | OTHER | 2441 | 01 | HEALTHSPRING | OTHER | 4710009 | 01 | UHC | OTHER | 510-83151 | 01 | AL | BC BS | OTHER | C76603 | 01 | VIVA | OTHER |