Provider Demographics
NPI:1235402090
Name:COTT, SARA (MSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:COTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E TRINITY PL STE 312
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3360
Mailing Address - Country:US
Mailing Address - Phone:404-850-1270
Mailing Address - Fax:844-471-7780
Practice Address - Street 1:125 E TRINITY PL STE 312
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-850-1270
Practice Address - Fax:844-471-7780
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0064431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009111Medicaid