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General NPI Number Information
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NPI Number | 1972611093
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Entity Type | Individual
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Provider Name | MANION MITCHELL COFFMAN DMD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 105 S HINE ST
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City | ATHENS
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State | AL
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Zip | 35611
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Country | US
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Telephone | 256-232-8214
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Fax | 256-232-3778
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Provider Business Mailing Address
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Address Line | 411 N JEFFERSON ST
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City | ATHENS
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State | AL
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Zip | 35611-1706
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Country | US
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Telephone | 256-505-2585
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Fax | 256-232-4619
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | AC 8716423
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3487
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License Number State | AL
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