Provider Demographics
NPI:1497553952
Name:BROWN-COTTOM, KATHRYN ELIZABETH (LDO)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:BROWN-COTTOM
Suffix:
Gender:
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 MARS HILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4943
Mailing Address - Country:US
Mailing Address - Phone:706-705-1613
Mailing Address - Fax:762-310-0055
Practice Address - Street 1:1260 MARS HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4943
Practice Address - Country:US
Practice Address - Phone:706-705-1613
Practice Address - Fax:762-310-0055
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002711156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier