Healthcare Provider Details

I. General information

NPI: 1023323888
Provider Name (Legal Business Name): BRIANA COSS HAYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANA DEE COSS

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 OLD HICKORY BLVD APT 105
NASHVILLE TN
37221-3719
US

IV. Provider business mailing address

2828 OLD HICKORY BLVD APT 105
NASHVILLE TN
37221-3719
US

V. Phone/Fax

Practice location:
  • Phone: 404-583-0575
  • Fax:
Mailing address:
  • Phone: 404-583-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3201050742719
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000038317
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: