Provider Demographics
NPI:1700963915
Name:COX, MARCELLA CHERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:CHERRY
Last Name:COX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:C
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1462 MONTREAL RD STE 303
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6924
Mailing Address - Country:US
Mailing Address - Phone:770-938-9761
Mailing Address - Fax:
Practice Address - Street 1:1462 MONTREAL RD STE 303
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6924
Practice Address - Country:US
Practice Address - Phone:770-938-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006129207Q00000X
GA057945207Q00000X, 208D00000X
ND11658208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N27520OtherMEDICARE GROUP PTAN