=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144260274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK F COFFEY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 05/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5629 HWY. 21 SOUTH
-----------------------------------------------------
City | RINCON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-295-2133
-----------------------------------------------------
Fax | 912-295-5924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5629 HWY. 21 SOUTH
-----------------------------------------------------
City | RINCON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-295-2133
-----------------------------------------------------
Fax | 912-295-5924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 27447
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 051450
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------