Provider Demographics
NPI:1538192745
Name:CORDLE, EMMETT PRICE (MD)
Entity type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:PRICE
Last Name:CORDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2018
Mailing Address - Country:US
Mailing Address - Phone:706-290-0098
Mailing Address - Fax:706-290-0941
Practice Address - Street 1:2110 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2018
Practice Address - Country:US
Practice Address - Phone:706-290-0098
Practice Address - Fax:706-290-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043911207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA043911OtherTAX IDENTIFICATION #
GA00758766EMedicaid
GA00758766EMedicaid
GA18BDFLGMedicare ID - Type Unspecified