MEDICARE: DR. NEYSA ALICE COKER D.M.D., M.D.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN014110	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760624332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEYSA ALICE COKER D.M.D., M.D.

Provider Business Mailing Address
First Line	:	85 GOLF CREST DR STE 209
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-2698
Country	:	US
Telephone Number	:	770-672-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 NANCY ST NW STE 150
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1377
Country	:	US
Telephone Number	:	770-672-5629
Fax Number	:

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

Provider Enumeration Date	:	03/29/2009
Last Update Date	:	06/29/2024

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