Provider Demographics
NPI:1346378692
Name:COHEN, KIM G (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:G
Last Name:COHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5078 SHADOW GLEN CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4304
Mailing Address - Country:US
Mailing Address - Phone:770-522-8352
Mailing Address - Fax:
Practice Address - Street 1:5078 SHADOW GLEN CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4304
Practice Address - Country:US
Practice Address - Phone:770-522-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAT941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist