Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 052664 | GA |
N | 2086S0129X | Vascular Surgeon | 23810 | SC |
NPI | 1043247232 |
---|---|
Provider Name | Edward J Cohn JR. |
First Address | Atlanta, GA 30368-6336 |
Second Address | Savannah, GA 31404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 09/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
557181803A | (05) | GA |
557181803B | (05) | GA |
557181803C | (05) | GA |
557181803D | (05) | GA |
G52664 | (02) | |
G52664 | (05) | SC |