Healthcare Provider Details

I. General information

NPI: 1801609995
Provider Name (Legal Business Name): ANNAH ELISABETH COKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BRADFORD ST NW
GAINESVILLE GA
30501-3210
US

IV. Provider business mailing address

447 BRADFORD ST NW
GAINESVILLE GA
30501-3210
US

V. Phone/Fax

Practice location:
  • Phone: 706-870-1331
  • Fax:
Mailing address:
  • Phone: 706-870-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC010143
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-78996
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: