Healthcare Provider Details

I. General information

NPI: 1710834981
Provider Name (Legal Business Name): LINDA MAYCI COATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VILLA NOVA ST
CUTHBERT GA
39840-6221
US

IV. Provider business mailing address

90 VILLA NOVA ST
CUTHBERT GA
39840-6221
US

V. Phone/Fax

Practice location:
  • Phone: 229-366-0906
  • Fax: 762-261-3105
Mailing address:
  • Phone: 229-366-0906
  • Fax: 762-261-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: