Provider Demographics
NPI:1518294859
Name:COWETA NEWNAN CLINICAL ASSOCIATES
Entity type:Organization
Organization Name:COWETA NEWNAN CLINICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:770-254-8278
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:SARGENT
Mailing Address - State:GA
Mailing Address - Zip Code:30275-0320
Mailing Address - Country:US
Mailing Address - Phone:770-253-3987
Mailing Address - Fax:
Practice Address - Street 1:91 OLIVER POTTS RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-3434
Practice Address - Country:US
Practice Address - Phone:770-253-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty