MEDICARE: MR. STUART JAY COHEN MED EDS

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	101Y00000X	Counselor	000290	GA
2	106H00000X	Marriage & Family Therapist	000279	GA

General Provider Information

NPI Number	:	1780675785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STUART JAY COHEN MED EDS

Provider Business Mailing Address
First Line	:	5555 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 330
City	:	ATLANTA
State	:	GA
Zip	:	30342-1703
Country	:	US
Telephone Number	:	404-843-0660
Fax Number	:	404-843-3633

Provider Business Practice Location Address
First Line	:	5555 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 330
City	:	ATLANTA
State	:	GA
Zip	:	30342-1703
Country	:	US
Telephone Number	:	404-843-0660
Fax Number	:	404-843-3633

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	09/11/2025

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