Provider Demographics
NPI:1982692125
Name:COHEN, DAVID LEONARD (DO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEONARD
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4323 MUNDY MILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2500
Mailing Address - Country:US
Mailing Address - Phone:770-534-2225
Mailing Address - Fax:470-290-8444
Practice Address - Street 1:4323 MUNDY MILL RD STE 101
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2500
Practice Address - Country:US
Practice Address - Phone:770-534-2225
Practice Address - Fax:470-290-8444
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA365489616AMedicare ID - Type Unspecified
GAD45095Medicare UPIN