Provider Demographics
NPI:1851030563
Name:COSENZA, JOHNNY (HADS001062)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:COSENZA
Suffix:
Gender:M
Credentials:HADS001062
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3415
Mailing Address - Country:US
Mailing Address - Phone:678-971-6227
Mailing Address - Fax:
Practice Address - Street 1:3839 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3415
Practice Address - Country:US
Practice Address - Phone:678-971-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001062332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHADS001062OtherWE ACCEPT NO INSURANCE