MEDICARE: DR. ELIZABETH JANE COETZEE M.D.

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	146D00000X	Personal Emergency Response Attendant	026243	GA

General Provider Information

NPI Number	:	1881786903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH JANE COETZEE M.D.

Provider Business Mailing Address
First Line	:	3965 CARRIAGE GATE DR
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5444
Country	:	US
Telephone Number	:	770-623-3004
Fax Number	:	770-623-3285

Provider Business Practice Location Address
First Line	:	9200 MARNE ROAD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	706-544-3711
Fax Number	:	706-544-2144

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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