Healthcare Provider Details

I. General information

NPI: 1154206985
Provider Name (Legal Business Name): ADELA COY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD STE 300
ATLANTA GA
30342-1713
US

IV. Provider business mailing address

5505 PEACHTREE DUNWOODY RD STE 300
ATLANTA GA
30342-1713
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0814
  • Fax:
Mailing address:
  • Phone: 404-257-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003685
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: