MEDICARE: MR. DAVID LEONARD COHEN D.O.

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	015567	GA

General Provider Information

NPI Number	:	1982692125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID LEONARD COHEN D.O.

Provider Business Mailing Address
First Line	:	4323 MUNDY MILL RD STE 101
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-2500
Country	:	US
Telephone Number	:	770-534-2225
Fax Number	:	470-290-8444

Provider Business Practice Location Address
First Line	:	4323 MUNDY MILL RD STE 101
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-2500
Country	:	US
Telephone Number	:	770-534-2225
Fax Number	:	470-290-8444

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/21/2022

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