1841310497 NPI number — DR. WALTER GREGORY COX PH.D.

Table of content: DR. WALTER GREGORY COX PH.D. (NPI 1841310497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841310497 NPI number — DR. WALTER GREGORY COX PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COX
Provider First Name:
WALTER
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1841310497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2923 PLAYER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31520-4950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-363-6378
Provider Business Mailing Address Fax Number:
912-264-1096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2130 SW JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97201-7709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-363-6378
Provider Business Practice Location Address Fax Number:
912-264-1096
Provider Enumeration Date:
03/29/2007

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: 103TH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 328437173B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1362 . This is a "PSYCHOLOGY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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