Provider Demographics
NPI:1124029798
Name:EVANS-COSBY, DEIRDRE (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:EVANS-COSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIEDMONT AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2544
Mailing Address - Country:US
Mailing Address - Phone:404-756-5271
Mailing Address - Fax:404-756-1402
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:STE 275
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-756-1400
Practice Address - Fax:404-756-5252
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0553972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA334204431FMedicaid
GA334204431DMedicaid
GA334204431FMedicaid
GA26BDJWDMedicare ID - Type Unspecified