Individual
SHARON DELOIS COGGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
115 BRUSHY CREEK RD, EASLEY, SC 29642-1120
(864) 546-4497
(864) 546-4506
Mailing address
PO BOX 484, EASLEY, SC 29641-0484
(864) 546-4497
(864) 546-4506
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
101057
NC
363AM0700X
Medical Physician Assistant
Primary
101057
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0543PA
—
SC
05
—
1669897724
—
NC
01
—
NCG210C
MEDICARE PTAN
NC
01
—
NCG210D
MEDICARE PTAN
NC
Enumeration date
06/09/2006
Last updated
02/20/2017
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