Individual
SHONTAE COGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
114 SHARTOM DR, AUGUSTA, GA 30907-4748
(706) 814-6777
(706) 814-6777
Mailing address
PO BOX 3043, AUGUSTA, GA 30914-3043
(706) 495-5364
(706) 814-6777
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
251300000X
Local Education Agency (LEA)
—
—
251E00000X
Home Health Agency
Primary
—
—
332U00000X
Home Delivered Meals
—
—
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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