MEDICARE: MARQUETA A COFFER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1578081808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUETA A COFFER

Provider Business Mailing Address
First Line	:	1380 BROCKETT PL
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021-3044
Country	:	US
Telephone Number	:	404-838-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 BROCKETT PL
Second Line	:
City	:	CLARKSTON
State	:	GA
Zip	:	30021
Country	:	US
Telephone Number	:	404-838-6662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	07/21/2022

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Directions to “ MARQUETA A COFFER ” Practice Location

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