MEDICARE: MRS. PATRICIA W. COSEY LICENSED PROFESSIONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	003066	GA
2	101YP2500X	Professional Counselor	003066LPCGA	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003844275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA W. COSEY LICENSED PROFESSIONA

Provider Business Mailing Address
First Line	:	1811 GREEN CIR STE B
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2784
Country	:	US
Telephone Number	:	229-244-9688
Fax Number	:	229-244-5354

Provider Business Practice Location Address
First Line	:	1811 GREEN CIR STE B
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2784
Country	:	US
Telephone Number	:	229-244-9688
Fax Number	:	229-244-5354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/06/2019

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