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General NPI Number Information
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NPI Number | 1639581903
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Entity Type | Individual
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Provider Name | ANDRE VICTOR COOMBS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 55 WHITCHER ST NE STE 130
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City | MARIETTA
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State | GA
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Zip | 30060-1156
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Country | US
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Telephone | 770-428-0462
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Fax |
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Provider Business Mailing Address
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Address Line | 11760 SW 40TH ST STE 722
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City | MIAMI
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State | FL
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Zip | 33175-8101
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Country | US
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Telephone | 305-559-1883
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Fax | 305-559-1887
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME146025
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 102468
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 102468
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License Number State | GA
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