Provider Demographics
NPI:1912718735
Name:COS, TRACEY (RDN, LD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:COS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CHATFIELD POINTE NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6205
Mailing Address - Country:US
Mailing Address - Phone:404-394-1316
Mailing Address - Fax:
Practice Address - Street 1:445 CHATFIELD POINTE NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6205
Practice Address - Country:US
Practice Address - Phone:404-394-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered