1619012879 NPI number — JEFF COHENOUR, MD, PC

Table of content: (NPI 1619012879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619012879 NPI number — JEFF COHENOUR, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFF COHENOUR, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619012879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 LAKES PKWY
Provider Second Line Business Mailing Address:
PATHOLOGY DEPT
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30043-5858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-237-4520
Provider Business Mailing Address Fax Number:
770-237-1920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 ALCOVY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30655-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-267-1891
Provider Business Practice Location Address Fax Number:
770-267-1798
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COHENOUR
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-267-1891

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  015238 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 033120 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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