Healthcare Provider Details

I. General information

NPI: 1316057821
Provider Name (Legal Business Name): MICHAEL ROBERT COHEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD SUITE 701
POOLER GA
31322-4052
US

IV. Provider business mailing address

PO BOX 15849
SAVANNAH GA
31416-2549
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-2280
  • Fax: 912-748-4988
Mailing address:
  • Phone: 912-748-2280
  • Fax: 912-748-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2005-00695
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: