Provider Demographics
NPI:1114037629
Name:MICHAEL J. COHEN, M.D., P.C.
Entity type:Organization
Organization Name:MICHAEL J. COHEN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-860-9210
Mailing Address - Street 1:1109 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6633
Mailing Address - Country:US
Mailing Address - Phone:706-860-9210
Mailing Address - Fax:706-860-8911
Practice Address - Street 1:1109 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 8B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6633
Practice Address - Country:US
Practice Address - Phone:706-860-9210
Practice Address - Fax:706-860-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19499174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00160652AMedicaid
GAD45089Medicare UPIN