Healthcare Provider Details

I. General information

NPI: 1154715175
Provider Name (Legal Business Name): REUVEN ZEV COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TULLIE RD NE
ATLANTA GA
30329-2309
US

IV. Provider business mailing address

1400 TULLIE RD NE
ATLANTA GA
30329-2309
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 404-785-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number80346
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: