Provider Demographics
NPI:1700471687
Name:COZART, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COZART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MORGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25813-7605
Mailing Address - Country:US
Mailing Address - Phone:865-712-1280
Mailing Address - Fax:
Practice Address - Street 1:301 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:GLEN MORGAN
Practice Address - State:WV
Practice Address - Zip Code:25813-7605
Practice Address - Country:US
Practice Address - Phone:865-712-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker