MEDICARE: DEIRDRE EVANS-COSBY MD

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	2084P0800X	Psychiatry Physician	055397	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124029798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE EVANS-COSBY MD

Provider Business Mailing Address
First Line	:	75 PIEDMONT AVE
Second Line	:	STE 700
City	:	ATLANTA
State	:	GA
Zip	:	30303-2544
Country	:	US
Telephone Number	:	404-756-5271
Fax Number	:	404-756-1402

Provider Business Practice Location Address
First Line	:	1800 HOWELL MILL RD NW
Second Line	:	STE 275
City	:	ATLANTA
State	:	GA
Zip	:	30318-2538
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:	404-756-5252

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/18/2015

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