Healthcare Provider Details

I. General information

NPI: 1831168640
Provider Name (Legal Business Name): JEFFREY SCOTT COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CANTON RD NE SUITE 315
MARIETTA GA
30060-7241
US

IV. Provider business mailing address

5667 PEACHTREE DUNWOODY RD NE SUITE 330
ATLANTA GA
30342-1725
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-7203
  • Fax: 770-794-7204
Mailing address:
  • Phone: 404-252-5669
  • Fax: 404-252-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number045427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: