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General NPI Number Information
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NPI Number | 1871746305
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Entity Type | Organization
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Legal Business Name | BARRY A. KOFFLER, M.D., P.C.
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 1295 HEMBREE RD SUITE 200 A
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City | ROSWELL
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State | GA
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Zip | 30076-5721
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Country | US
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Telephone | 770-475-1279
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Fax | 770-442-5444
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Provider Business Mailing Address
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Address Line | 1295 HEMBREE RD SUITE 200 A
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City | ROSWELL
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State | GA
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Zip | 30076-5721
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Country | US
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Telephone | 770-475-1279
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Fax | 770-442-5444
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY A. KOFFLER
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Credential | M.D.
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Telephone | 770-475-1279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 019540
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License Number State | GA
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