MR. RALLIE D COGBURN SR. (NPI# 1548265549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548265549 |
| Entity Type | Individual |
| Full Name | MR. RALLIE D COGBURN SR. |
| Credential | PA |
| Practice Address |
6070 Lakeside Commons Dr Macon GA 31210-5778 |
| Mailing Address |
Po Box 26790 Macon GA 31221-6790 |
| Practice Telephone | 4782542644 |
| Practice Fax Number | 4782544924 |
| Mailing Telephone | 4782542644 |
| Mailing Fax Number | 4782544924 |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2014-10-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
003476 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00317358L | 05 | |
| GA | 100002802B | 05 | |
| GA | 100002802A | 05 |
| Street Address |
6070 LAKESIDE COMMONS DR |
| City | MACON |
| State | GA |
| Zip Code | 31210-5778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194350546 | Serwah Sarponma Amponsah | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2020-03-05 |
| 1336791292 | Morgan Dowd | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2019-07-11 |
| 1740849082 | Heather Hall | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2019-06-11 |
| 1588153498 | Stephanie Van Dine | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2018-05-07 |
| 1598028060 | Susannah Burns Goodman | Nurse Practitioner | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2012-06-20 |
| 1205113057 | Middle Georgia Heart and Vascular Center, LLC | Internal Medicine | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2011-11-08 |
| 1376873513 | Angela Rhea Ballard | Physician Assistant | 6070 Lakeside Commons Dr, Macon, GA 31210 | 2010-01-11 |
| 1962650440 | Olexandr V. Smolensky | Internal Medicine | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2008-09-08 |
| 1922007541 | William Douglas Knopf | Internal Medicine | 6070 Lakeside Commons Dr, Macon, GA 31210-5778 | 2005-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033309075 | Heidi Mans Atkins | Physician Assistant | 556 3rd St Ste A, Macon, GA 31201 | 2007-07-26 |
| 1982648200 | Gretchen D Suk | Physician Assistant | 1062 Forsyth St, Suite 1b, Macon, GA 31201-8637 | 2006-06-16 |
| 1295732576 | Christine Harrell | Physician Assistant | 1062 Forsyth St Ste 2e, Macon, GA 31201-8631 | 2005-07-01 |
| 1942845375 | Emily Kerns | Physician Assistant | 1201 N Rutherford St, Macon, MO 63552-2020 | 2019-11-08 |
| 1245708072 | Amberly Hardison | Physician Assistant | 124 3rd St, Macon, GA 31201-3404 | 2018-11-09 |
| 1407266968 | Patricia Frances Baldwin | Physician Assistant | 400 Charter Blvd, Macon, GA 31210-4831 | 2014-05-05 |
| 1033405477 | Rachel Hinson Youngblood | Physician Assistant | 800 1st St Ste 410, Macon, GA 31201-8306 | 2011-06-23 |
| 1740598648 | Beth Scoggan Costolnick | Physician Assistant | 550 Professional Dr, Macon, GA 31201-1411 | 2010-09-14 |
| 1134452568 | Deana J Porter | Physician Assistant | 210 Mercer Jct, Macon, GA 31210-4016 | 2009-09-17 |
| 1962634451 | Harry Tinley (tim) Reynolds | Physician Assistant | 556 3rd St, Suite A, Macon, GA 31201-7934 | 2009-08-17 |
| Find all providers in MACON | ||||
Please comment or provide details below to improve the information on MR. RALLIE D COGBURN SR..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.