Provider Demographics
NPI:1619012879
Name:JEFF COHENOUR, MD, PC
Entity type:Organization
Organization Name:JEFF COHENOUR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:COHENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-267-1891
Mailing Address - Street 1:1605 LAKES PKWY
Mailing Address - Street 2:PATHOLOGY DEPT
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5858
Mailing Address - Country:US
Mailing Address - Phone:770-237-4520
Mailing Address - Fax:770-237-1920
Practice Address - Street 1:330 ALCOVY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2140
Practice Address - Country:US
Practice Address - Phone:770-267-1891
Practice Address - Fax:770-267-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015238291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033120OtherBCBS
GA033120OtherBCBS