Healthcare Provider Details

I. General information

NPI: 1659697761
Provider Name (Legal Business Name): JEAN LOUISE KOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BUILDING B, SUITE 4300
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE BUILDING B, SUITE 4300
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5210
  • Fax: 404-778-3366
Mailing address:
  • Phone: 404-778-5210
  • Fax: 404-778-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number68230
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: