Healthcare Provider Details

I. General information

NPI: 1811451768
Provider Name (Legal Business Name): SHARON COSBY CPRP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5386 SNAPFINGER WOODS DR
DECATUR GA
30035-4027
US

IV. Provider business mailing address

5386 SNAPFINGER WOODS DR
DECATUR GA
30035-4027
US

V. Phone/Fax

Practice location:
  • Phone: 404-975-4684
  • Fax: 470-657-2524
Mailing address:
  • Phone: 404-975-4684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number4894340
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: