Healthcare Provider Details

I. General information

NPI: 1073745220
Provider Name (Legal Business Name): BARBARA JEAN CONYERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA JEAN COFFEY FNP

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3541 CHATTANOOGA RD
TUNNEL HILL GA
30755-9393
US

IV. Provider business mailing address

3541 CHATTANOOGA RD
TUNNEL HILL GA
30755-9393
US

V. Phone/Fax

Practice location:
  • Phone: 706-516-4426
  • Fax: 706-516-4429
Mailing address:
  • Phone: 706-516-4426
  • Fax: 706-516-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14164
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN163150 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: