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NPI Code Detail

MEDICARE: BERETTA CRAFT-COFFMAN P.A.-C

MEDICARE: BERETTA CRAFT-COFFMAN P.A.-C
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
1363AS0400XSurgical Physician AssistantPA.0004259CO
2363AS0400XSurgical Physician AssistantPA9106348FL
3363AS0400XSurgical Physician AssistantPA2198NV
4363AS0400XSurgical Physician Assistant0010-10058NC
5363AS0400XSurgical Physician AssistantPA00325MS
6363AS0400XSurgical Physician Assistant1199SC
7363AS0400XSurgical Physician AssistantPA0659NV
8363AS0400XSurgical Physician AssistantPA0000001672TN
9363AS0400XSurgical Physician AssistantPA09999TX
10363AS0400XSurgical Physician Assistant0110007147VA
11363AS0400XSurgical Physician Assistant002366GA

General Provider Information

NPI Number : 1285601880
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERETTA CRAFT-COFFMAN P.A.-C
Provider Business Mailing Address
First Line : 626 BENT CREEK DR
Second Line :
City : EVANS
State : GA
Zip : 30809-7445
Country : US
Telephone Number : 706-833-8983
Fax Number :
Provider Business Practice Location Address
First Line : 125 OAKSIDE CT STE 102
Second Line :
City : CANTON
State : GA
Zip : 30114-2498
Country : US
Telephone Number : 770-213-8376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2006
Last Update Date : 06/20/2025

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