Healthcare Provider Details

I. General information

NPI: 1043247232
Provider Name (Legal Business Name): EDWARD J COHN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JERRY COHN JR. M.D.

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 WATERS AVE SUITE 500
SAVANNAH GA
31404
US

IV. Provider business mailing address

PO BOX 116336
ATLANTA GA
30368-6336
US

V. Phone/Fax

Practice location:
  • Phone: 866-957-8346
  • Fax: 912-355-1414
Mailing address:
  • Phone: 866-957-8346
  • Fax: 912-355-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number23810
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number052664
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: