Healthcare Provider Details

I. General information

NPI: 1174416440
Provider Name (Legal Business Name): NATAYA COTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 PEACHTREE RD NE STE 115
ATLANTA GA
30326-1963
US

IV. Provider business mailing address

250 HIGH ST APT 357
ATLANTA GA
30346-1121
US

V. Phone/Fax

Practice location:
  • Phone: 770-450-1899
  • Fax:
Mailing address:
  • Phone: 470-370-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN099459
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: