Healthcare Provider Details

I. General information

NPI: 1275569055
Provider Name (Legal Business Name): SANDRA W COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GERMANTOWN CT SUITE 100
CORDOVA TN
38018-7273
US

IV. Provider business mailing address

PO BOX 1000 DEPT # 457
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-758-7888
  • Fax: 901-266-6445
Mailing address:
  • Phone: 901-758-7888
  • Fax: 901-266-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44372
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number147466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: