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General NPI Number Information
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NPI Number | 1285601880
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Entity Type | Individual
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Provider Name | BERETTA CRAFT-COFFMAN P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 125 OAKSIDE CT STE 102
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City | CANTON
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State | GA
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Zip | 30114-2498
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Country | US
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Telephone | 770-213-8376
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Fax |
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Provider Business Mailing Address
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Address Line | 626 BENT CREEK DR
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City | EVANS
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State | GA
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Zip | 30809-7445
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Country | US
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Telephone | 706-833-8983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0004259
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9106348
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA2198
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-10058
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA00325
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License Number State | MS
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Taxonomy #6
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1199
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License Number State | SC
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Taxonomy #7
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA0659
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License Number State | NV
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Taxonomy #8
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA0000001672
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License Number State | TN
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Taxonomy #9
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA09999
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License Number State | TX
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Taxonomy #10
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110007147
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License Number State | VA
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Taxonomy #11
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 002366
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License Number State | GA
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