MEDICARE: COZY KENYA ADAMS LPN

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	164W00000X	Licensed Practical Nurse	LPN087292	GA

General Provider Information

NPI Number	:	1427739655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COZY KENYA ADAMS LPN

Provider Business Mailing Address
First Line	:	950 EAGLES LANDING PKWY # 793
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7343
Country	:	US
Telephone Number	:	678-814-6671
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 SEDONA LOOP # 793
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-2554
Country	:	US
Telephone Number	:	678-814-6671
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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