Healthcare Provider Details

I. General information

NPI: 1417089475
Provider Name (Legal Business Name): PAUL JASON COHEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAKE FORREST DR NW SUITE 575
ATLANTA GA
30328-3824
US

IV. Provider business mailing address

3500 CEDAR KNOLL DR
ROSWELL GA
30076-2899
US

V. Phone/Fax

Practice location:
  • Phone: 770-639-2880
  • Fax: 404-255-3234
Mailing address:
  • Phone: 770-649-9381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2928
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2928
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2928
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2928
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2928
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: