Individual
WENDY LYNN COTO-PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 535-3611
(770) 535-7092
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
059908
GA
208000000X
Pediatrics Physician
A108494
CA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
059908
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01674418
AMERIGROUP
GA
01
—
52597492
BCBS OF GEORGIA
GA
01
—
712419
WELLCARE HEALTH PLANS
GA
Enumeration date
01/17/2008
Last updated
01/15/2013
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