Provider Demographics
NPI:1922343359
Name:THE COUSIN FAMILY LLC
Entity Type:Organization
Organization Name:THE COUSIN FAMILY LLC
Other - Org Name:THE COUSIN AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CSA
Authorized Official - Phone:770-875-1243
Mailing Address - Street 1:2847 VETERANS MEMORIAL HWY SW UNIT 888
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1108
Mailing Address - Country:US
Mailing Address - Phone:770-875-1243
Mailing Address - Fax:
Practice Address - Street 1:2847 VETERANS MEMORIAL HWY SW UNIT 888
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-1108
Practice Address - Country:US
Practice Address - Phone:770-875-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty