Provider Demographics
NPI:1720337439
Name:COUSIN, HERBERT LOUIS JR (CSA)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:LOUIS
Last Name:COUSIN
Suffix:JR
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2537 CEDARCREST RD STE 305-63
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8900
Mailing Address - Country:US
Mailing Address - Phone:762-235-4343
Mailing Address - Fax:
Practice Address - Street 1:2537 CEDARCREST RD STE 305-63
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8900
Practice Address - Country:US
Practice Address - Phone:762-235-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical