# COFFEE FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053470617
- **Authorized official:** LYDIA TANNER (CEO)
- **Authorized official phone:** (912) 384-2353

## Contact information

- **Practice address:** 200 DOCTORS DR, STE 224, DOUGLAS, GA 31533-2201
- **Practice address phone:** (912) 384-2353
- **Mailing address:** 200 DOCTORS DR, STE 224, DOUGLAS, GA 31533-2201
- **Mailing address phone:** (912) 384-2353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 08/22/2020