Healthcare Provider Details

I. General information

NPI: 1861450702
Provider Name (Legal Business Name): CYNTHIA COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE RM. G144
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1364 CLIFTON RD NE RM. G144
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-7005
  • Fax: 404-712-4754
Mailing address:
  • Phone: 404-712-7005
  • Fax: 404-712-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number027979
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number027979
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number027979
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number027979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: