Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 037424 | GA |
NPI | 1023036803 |
---|---|
Provider Name | Cheryl Wonderly Cockrell |
First Address | Stockbridge, GA 30281 |
Second Address | Stockbridge, GA 30281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05560788B | (05) | GA |
D55115 | (02) |