Provider Demographics
NPI:1073858320
Name:COSLICK, NORMAN BAUER (LAC)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:BAUER
Last Name:COSLICK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5245
Mailing Address - Country:US
Mailing Address - Phone:912-308-1103
Mailing Address - Fax:
Practice Address - Street 1:716 E 71ST ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4907
Practice Address - Country:US
Practice Address - Phone:912-308-1103
Practice Address - Fax:912-201-3327
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist