Provider Demographics
NPI:1689993081
Name:COHEN, NICOLE MOMBERG (MD MBA MSMS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MOMBERG
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD MBA MSMS
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Mailing Address - Street 1:6602 WATERS AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2778
Mailing Address - Country:US
Mailing Address - Phone:912-350-6000
Mailing Address - Fax:912-350-6001
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:BLDG A 1ST FLOOR
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-350-6000
Practice Address - Fax:912-350-6001
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2022-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA070362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGA1547Medicaid
GA003136114AMedicaid
GA003136114BMedicaid
GAP01198997OtherRAILROAD MEDICARE
GA202I118158Medicare PIN