Healthcare Provider Details

I. General information

NPI: 1669363610
Provider Name (Legal Business Name): NATAVION COWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 INTERSTATE NORTH CIR SE
ATLANTA GA
30339-2425
US

IV. Provider business mailing address

294 INTERSTATE NORTH CIR SE
ATLANTA GA
30339-2425
US

V. Phone/Fax

Practice location:
  • Phone: 470-588-8484
  • Fax: 855-915-0244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-444739
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: