Provider Demographics
NPI:1134426596
Name:COSBY, LOLA Y (RN)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:Y
Last Name:COSBY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 CRAWFORDVILLE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9462
Mailing Address - Country:US
Mailing Address - Phone:706-306-1240
Mailing Address - Fax:
Practice Address - Street 1:3603 CRAWFORDVILLE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9462
Practice Address - Country:US
Practice Address - Phone:706-306-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR51534163W00000X
GARN090851163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse