Provider Demographics
NPI:1043247232
Name:COHN, EDWARD J JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:COHN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:COHN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 116336
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6336
Mailing Address - Country:US
Mailing Address - Phone:866-957-8346
Mailing Address - Fax:912-355-1414
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:866-957-8346
Practice Address - Fax:912-355-1414
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC238102086S0129X
GA0526642086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA557181803CMedicaid
GA557181803RMedicaid
SCG52664Medicaid
GA557181803PMedicaid
GA557181803DMedicaid
GAP00035168Medicare PIN
GA511I020137Medicare PIN
SCG52664Medicaid
GA557181803CMedicaid
GA557181803AMedicaid