MEDICARE: GAVIN COHEN

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	152W00000X	Optometrist	1768	GA

General Provider Information

NPI Number	:	1760512040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVIN COHEN

Provider Business Mailing Address
First Line	:	1244 W PACES FERRY RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	404-844-1500
Fax Number	:	404-844-2700

Provider Business Practice Location Address
First Line	:	1244 W PACES FERRY RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	404-844-1500
Fax Number	:	404-844-2700

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/09/2007

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Directions to “ GAVIN COHEN ” Practice Location

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