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NPI Code Detail

MEDICARE: MRS. SHARON COFFIELD LOGAN PA-C

MEDICARE: MRS. SHARON COFFIELD LOGAN PA-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 Assistant4536GA
2363A00000XPhysician Assistant4536GA

General Provider Information

NPI Number : 1861445215
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHARON COFFIELD LOGAN PA-C
Provider Business Mailing Address
First Line : 3647 J DEWEY GRAY CIR STE 200
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-2205
Country : US
Telephone Number : 706-504-9712
Fax Number : 706-504-9703
Provider Business Practice Location Address
First Line : 3647 J DEWEY GRAY CIR STE 200
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-2205
Country : US
Telephone Number : 706-504-9712
Fax Number : 706-504-9703
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 03/31/2020

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Directions to “ MRS. SHARON COFFIELD LOGAN PA-C” Practice Location

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