Individual provider Active NPI

Shany Cohen-Sadan

  • Family Medicine Physician
  • Cumming, GA
National Provider Identifier
1114505435
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
101590 Issued in GA
Practice address
610 Peachtree Pkwy Ste 130
Cumming, GA 30041-9778
Phone
(770) 205-2804
Fax
(770) 205-2854
NPI assigned
Mar 30, 2021
Last updated
Oct 23, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 101590 GA Primary

Addresses

Primary practice location

610 Peachtree Pkwy Ste 130
Cumming, GA 30041-9778

Mailing address

4561 Edgemere Trce
Marietta, GA 30062-5779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240916001326 GA Practitioner - Family Practice 7416359690 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Urgent Care Holding LLCGroup PAC ID 4587984695, 77 clinicians

Practice addresses (Care Compare)

1110 W Peachtree St NW
Suite 200
Atlanta, GA 30309-3609
Phone (404) 575-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Primary Care Professional Services, LLC CurrentSince Sep 17, 2024 Accepting new patients
Northside Urgent Care Holding, LLC CurrentSince Sep 17, 2024 Accepting new patients
Northside Primary Care Professional Services,LLC Family Medicine CurrentSince Sep 17, 2024 Accepting new patients
Internal Medicine Associates of Johns Creek Past Accepting new patients

Locations

1110 W Peachtree St NW
Ste 200
Atlanta, GA 30309
Phone (404) 575-2000

1110 W Peachtree St NW
Ste 200B
Atlanta, GA 30309
Phone (404) 575-2000

610 Peachtree Pkwy
Ste 130
Cumming, GA 30041
Phone (770) 205-2804

81 Northside Dawson Dr
Ste 100A
Dawsonville, GA 30534
Phone (706) 216-6000

4800 Olde Towne Pkwy
Ste 150
Marietta, GA 30068
Phone (770) 509-1025

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

3350 Paddocks Pkwy
Suwanee, GA 30024
Phone (678) 474-9633

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1114505435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4561 EDGEMERE TRCE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 PEACHTREE PKWY STE 130",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419778",
            "telephone_number": "770-205-2804",
            "fax_number": "770-205-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COHEN-SADAN",
        "first_name": "SHANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "101590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.