1346565157 NPI number — DR. MAREN ELIZABETH SPECK COTES M.D.

Table of content: DR. MAREN ELIZABETH SPECK COTES M.D. (NPI 1346565157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346565157 NPI number — DR. MAREN ELIZABETH SPECK COTES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTES
Provider First Name:
MAREN
Provider Middle Name:
ELIZABETH SPECK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPECK
Provider Other First Name:
MAREN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346565157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4285 JOHNS CREEK PKWY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-622-4412
Provider Business Mailing Address Fax Number:
770-622-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4285 JOHNS CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-6038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-622-4412
Provider Business Practice Location Address Fax Number:
770-622-4191
Provider Enumeration Date:
04/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  5119 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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