Provider Demographics
NPI:1487950549
Name:COZART & ASSOCIATES PLLC, WILEY SIMEON COZART III SOLE MBR
Entity type:Organization
Organization Name:COZART & ASSOCIATES PLLC, WILEY SIMEON COZART III SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:SIMEON
Authorized Official - Last Name:COZART
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:828-884-4433
Mailing Address - Street 1:344 GALLIMORE RD
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-8874
Mailing Address - Country:US
Mailing Address - Phone:828-884-4433
Mailing Address - Fax:828-884-7875
Practice Address - Street 1:344 GALLIMORE ROAD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-8874
Practice Address - Country:US
Practice Address - Phone:828-884-4433
Practice Address - Fax:828-884-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7991840Medicaid