Michael Brent Koch, M.D.
Individual provider Active NPI General Acute Care Hospital · Smyrna, GA
NPI 1508900101 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508900101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 043075 (GA)
- Practice address
- 3949 S Cobb Dr SE
Smyrna, GA 30080-6342 - Phone
- (770) 438-5215
- NPI assigned
- Feb 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040805000366 | GA | Practitioner - Pathology | 7719958339 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chestatee Pathology Associates, PC | Current |
Accepting new patients | |
| B. Timothy Schaeffer MD PC | Past | Accepting new patients |
Locations
428 Winn Ct
Decatur, GA 30030
Phone (404) 292-3727
2242 Northwest Pkwy SE
Ste A2
Marietta, GA 30067
Phone (770) 384-0284
3949 S Cobb Dr SE
Smyrna, GA 30080
Phone (770) 434-0710
5700 Southwyck Blvd
Toledo, OH 43614
Interoperability endpoints
- mkoch44444@direct.emory.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 043075 | GA | Yes |
Addresses
Primary practice location
3949 S Cobb Dr SE
Smyrna, GA 30080-6342
Mailing address
50 Lullwater Estates Rd.
Atlanta, GA 30307
Phone (404) 378-1864
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00935129B | Medicaid | GA |
Other providers in Smyrna, GA
- Jeffrey H Klopper
- Mia Marie Knight
- Julie Ellen Knop
- Amanda Pyatt Knowles
- Jennifer Koch
- Barbara Koloze
- Rachel Kopkin
- Kostas Chiropractic Clinics, PC
- Michael John Kostas
- Candace Hines Kotei
All providers in Smyrna, GA · General Acute Care Hospital in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.