Provider Demographics
NPI:1659026029
Name:COSNAHAN, JAMES WESLEY (CPNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WESLEY
Last Name:COSNAHAN
Suffix:
Gender:M
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LIVE OAK CT
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-8785
Mailing Address - Country:US
Mailing Address - Phone:478-973-1499
Mailing Address - Fax:
Practice Address - Street 1:5040 BILL GARDNER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3758
Practice Address - Country:US
Practice Address - Phone:678-583-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN274857163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse