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General NPI Number Information
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NPI Number | 1518294859
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Entity Type | Organization
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Legal Business Name | COWETA NEWNAN CLINICAL ASSOCIATES
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 91 OLIVER POTTS RD
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City | NEWNAN
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State | GA
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Zip | 30263-3434
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Country | US
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Telephone | 770-253-3987
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320
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City | SARGENT
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State | GA
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Zip | 30275-0320
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Country | US
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Telephone | 770-253-3987
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MS. DOROTHY COHEN
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Credential | MSW
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Telephone | 770-254-8278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1608
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License Number State | GA
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