Provider Demographics
NPI:1053364166
Name:COLE, HARVEY PENFIELD III (MD)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:PENFIELD
Last Name:COLE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARVEY
Other - Middle Name:CHIP
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 640
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-256-1500
Mailing Address - Fax:404-256-2006
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-256-1500
Practice Address - Fax:404-256-2006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035594207W00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000503753CMedicaid
24BCBLMMedicare ID - Type Unspecified
E57952Medicare UPIN