MEDICARE: DR. LOUIS VICTOR COHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	022496	GA

General Provider Information

NPI Number	:	1639260433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS VICTOR COHEN M.D.

Provider Business Mailing Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE A10
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	770-565-4317
Fax Number	:	770-565-4319

Provider Business Practice Location Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE A10
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	770-565-4317
Fax Number	:	770-565-4319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/18/2012

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