Healthcare Provider Details

I. General information

NPI: 1356401996
Provider Name (Legal Business Name): COFFEE COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 PETERSON AVE S
DOUGLAS GA
31533-4401
US

IV. Provider business mailing address

1311 PETERSON AVE S
DOUGLAS GA
31533-4401
US

V. Phone/Fax

Practice location:
  • Phone: 912-383-5338
  • Fax: 912-383-5439
Mailing address:
  • Phone: 912-383-5338
  • Fax: 912-383-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PATSY MOORE
Title or Position: MEDICIAD CLERK
Credential:
Phone: 912-383-5338