Healthcare Provider Details

I. General information

NPI: 1356907596
Provider Name (Legal Business Name): HANNAH TIMMERMAN COFER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3486 PEACH ORCHARD RD
AUGUSTA GA
30906-5214
US

IV. Provider business mailing address

PO BOX 1705
AUGUSTA GA
30903-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-828-8049
  • Fax:
Mailing address:
  • Phone: 706-854-6008
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN216627
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN216627
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: