MEDICARE: DR. MARCELLA CHERRY COX D.O.

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	207Q00000X	Family Medicine Physician	006129	AZ
2	207Q00000X	Family Medicine Physician	057945	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N27520	OTHER	MI	MEDICARE GROUP PTAN

General Provider Information

NPI Number	:	1700963915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELLA CHERRY COX D.O.

Provider Business Mailing Address
First Line	:	1462 MONTREAL RD STE 303
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-6924
Country	:	US
Telephone Number	:	770-938-9761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1462 MONTREAL RD STE 303
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-6924
Country	:	US
Telephone Number	:	770-938-9761
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/21/2022

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