Provider Demographics
NPI:1083699219
Name:COHEN, JONATHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 AIRPARK DR
Mailing Address - Street 2:BEHAVIORAL HEALTH ASSOCIATES
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-899-0024
Mailing Address - Fax:423-899-5688
Practice Address - Street 1:6216 AIRPARK DR
Practice Address - Street 2:BEHAVIORAL HEALTH ASSOCIATES
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-899-0024
Practice Address - Fax:423-899-5688
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD197172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
3069665OtherBLUE CROSS BLUE SHIELD
TN3047846Medicaid
E17902Medicare UPIN
TN3047846Medicaid