1043710916 NPI number — DRAUGHN COGGINS & MOORE CONSULTANT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043710916 NPI number — DRAUGHN COGGINS & MOORE CONSULTANT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRAUGHN COGGINS & MOORE CONSULTANT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043710916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 MORGAN WIELAND LN APT 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33813-3189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-852-6760
Provider Business Mailing Address Fax Number:
863-209-7991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 MORGAN WIELAND LN APT 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33813-3189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-852-6760
Provider Business Practice Location Address Fax Number:
863-209-7991
Provider Enumeration Date:
02/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JULIUS
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PARTNER/ MEDICAL DIRECTOR
Authorized Official Telephone Number:
863-333-1018

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME21858 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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