Healthcare Provider Details

I. General information

NPI: 1285224014
Provider Name (Legal Business Name): ANGELA DAWN COFFEEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DR STE 404
AUSTELL GA
30106-8116
US

IV. Provider business mailing address

672 BRAIDWOOD TER NW
ACWORTH GA
30101-3512
US

V. Phone/Fax

Practice location:
  • Phone: 770-428-4475
  • Fax:
Mailing address:
  • Phone: 404-395-2576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN203745
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: