Provider Demographics
NPI:1922156611
Name:COSGROVE, JULIE CLAIRE (CPNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CLAIRE
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 VILLA RICA WAY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5741
Mailing Address - Country:US
Mailing Address - Phone:678-504-1189
Mailing Address - Fax:678-504-1175
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:BLDG. 2, STE. C
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6458
Practice Address - Country:US
Practice Address - Phone:770-425-5331
Practice Address - Fax:770-425-0799
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA105376363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics