Provider Demographics
NPI:1043483001
Name:COCHRAN, LAURIE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELIZABETH
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N LEE ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-2122
Mailing Address - Country:US
Mailing Address - Phone:478-994-0437
Mailing Address - Fax:478-994-6787
Practice Address - Street 1:120 N LEE ST STE A
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-2122
Practice Address - Country:US
Practice Address - Phone:478-994-0437
Practice Address - Fax:478-994-6787
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.2918207Q00000X
GA063767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100996AMedicaid
GA202I087530Medicare PIN