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NPI Code Detail

MEDICARE: DANIEL BLAKE COHEN PA-S

MEDICARE: DANIEL BLAKE COHEN PA-S
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
1390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1821957887
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL BLAKE COHEN PA-S
Provider Business Mailing Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 800-637-2378
Fax Number :
Provider Business Practice Location Address
First Line : 3001 MERCER UNIVERSITY DR
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4115
Country : US
Telephone Number : 800-637-2378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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