Individual
MICHAEL BRENT KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3949 S COBB DR SE, SMYRNA, GA 30080-6342
(770) 438-5215
Mailing address
50 LULLWATER ESTATES RD., ATLANTA, GA 30307
(404) 378-1864
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
043075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00935129B
—
GA
Enumeration date
02/16/2007
Last updated
07/08/2007
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