Individual
CARLOS MIGUEL COSSIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1077 BAXTER ST, SUITE K, ATHENS, GA 30606-3767
(706) 613-0313
(706) 613-0229
Mailing address
1077 BAXTER ST, SUITE K, ATHENS, GA 30606-3767
(706) 613-0313
(706) 613-0229
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036127
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00544123D
—
GA
Enumeration date
07/15/2005
Last updated
08/17/2009
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