MEDICARE: DR. COURTNEY ELIZABETH 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	2024-00686	NC

General Provider Information

NPI Number	:	1790426682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY ELIZABETH COSBY MD

Provider Business Mailing Address
First Line	:	7002 MICHIGAN AVE UNIT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-2838
Country	:	US
Telephone Number	:	901-581-2238
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 3RD ST FL 2
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6967
Country	:	US
Telephone Number	:	336-832-9626
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	02/06/2026

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