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NPI Code Detail

MEDICARE: BRIDGET T COFFEY RD

MEDICARE: BRIDGET T COFFEY RD
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
1133V00000XRegistered DietitianLD000471GA

General Provider Information

NPI Number : 1659334266
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET T COFFEY RD
Provider Business Mailing Address
First Line : 1455 MONTREAL RD
Second Line :
City : TUCKER
State : GA
Zip : 30084-8100
Country : US
Telephone Number : 770-270-3219
Fax Number :
Provider Business Practice Location Address
First Line : 1455 MONTREAL RD
Second Line :
City : TUCKER
State : GA
Zip : 30084-8100
Country : US
Telephone Number : 770-270-3219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 07/08/2007

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Directions to “ BRIDGET T COFFEY RD” Practice Location

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