Healthcare Provider Details

I. General information

NPI: 1023204823
Provider Name (Legal Business Name): IRAISA M JOSEPHA COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2007
Last Update Date: 09/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 PEACHTREE DUNWOODY RD NE SUITE 102 BLG-1
ATLANTA GA
30328-1610
US

IV. Provider business mailing address

6849 PEACHTREE DUNWOODY RD NE SUITE 102 BLG-1
ATLANTA GA
30328-1610
US

V. Phone/Fax

Practice location:
  • Phone: 866-587-9922
  • Fax: 678-587-9993
Mailing address:
  • Phone: 866-587-9922
  • Fax: 678-587-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberOTA001020
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: