Provider Demographics
NPI:1508835638
Name:COHEN, STANLEY A (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:A
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 1:993-D JOHNSON FERRY ROAD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-257-0799
Mailing Address - Fax:404-503-2280
Practice Address - Street 1:993-D JOHNSON FERRY ROAD
Practice Address - Street 2:SUITE 440
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-257-0799
Practice Address - Fax:404-503-2280
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0209772080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0002010011GMedicaid
52026134007OtherBLUE CHOICE PROVIDER IDS
REF000016293OtherMEDICAID REFERENCE PROVID
1000OtherKAIER
2134605OtherAETNA HMO POS
1764658006OtherCIGNA
0052506OtherUNITED HEALTH CARE
134520OtherBLUE CHOICE FAC INS
4060324OtherAETNA MC PPO PIN