MEDICARE: MRS. TIFFINY B COHEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	004491	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004491	OTHER	GA	PHYSICIAN ASSISTANT

General Provider Information

NPI Number	:	1396732269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFINY B COHEN PA-C

Provider Business Mailing Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	SUITE 102
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	770-497-0699
Fax Number	:	770-497-0388

Provider Business Practice Location Address
First Line	:	10700 MEDLOCK BRIDGE RD
Second Line	:	SUITE 102
City	:	DULUTH
State	:	GA
Zip	:	30097-8456
Country	:	US
Telephone Number	:	770-497-0699
Fax Number	:	770-497-0388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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