Provider Demographics
NPI:1831896976
Name:KOSATKA, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:KOSATKA
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 1:6371 SEYMOUR PL NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8063
Mailing Address - Country:US
Mailing Address - Phone:800-370-0393
Mailing Address - Fax:
Practice Address - Street 1:6371 SEYMOUR PL NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8063
Practice Address - Country:US
Practice Address - Phone:800-370-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-257496103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst