Provider Demographics
NPI:1487652020
Name:COHEN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
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 1:308 COLISEUM DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3876
Mailing Address - Country:US
Mailing Address - Phone:478-742-2180
Mailing Address - Fax:478-745-2623
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3876
Practice Address - Country:US
Practice Address - Phone:478-742-2180
Practice Address - Fax:478-745-2623
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037176207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000700477AMedicaid
GAG26010Medicare UPIN
07BBSGVMedicare ID - Type Unspecified