MEDICARE: MRS. JANNA COKER MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	PCET002168	GA

General Provider Information

NPI Number	:	1154782928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANNA COKER MS

Provider Business Mailing Address
First Line	:	110 PIPEMAKERS CIR STE 115
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4168
Country	:	US
Telephone Number	:	912-988-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 PIPEMAKERS CIR STE 115
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4168
Country	:	US
Telephone Number	:	912-988-1526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	03/08/2016

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