MEDICARE: MR. COY EDWARD FLETCHER L.P.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
1	101YP2500X	Professional Counselor	LPC003527	GA

General Provider Information

NPI Number	:	1932182706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COY EDWARD FLETCHER L.P.C.

Provider Business Mailing Address
First Line	:	2150 PEACHFORD RD
Second Line	:	SUITE R
City	:	ATLANTA
State	:	GA
Zip	:	30338-6520
Country	:	US
Telephone Number	:	770-455-0261
Fax Number	:	866-338-1187

Provider Business Practice Location Address
First Line	:	2150 PEACHFORD RD
Second Line	:	SUITE R
City	:	ATLANTA
State	:	GA
Zip	:	30338-6520
Country	:	US
Telephone Number	:	770-455-0261
Fax Number	:	866-338-1187

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

Provider Enumeration Date	:	11/24/2005
Last Update Date	:	07/08/2007

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