# COFFEE FAMILY MEDICINE, PC

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

## Provider details

- **NPI number:** 1265456669
- **Authorized official:** DR. LYDIA TANNER M.D. (PHYSICIAN)
- **Authorized official phone:** (912) 384-2353

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 53885 | GA | Yes |
| 363A00000X | Physician Assistant | 004691 | GA | — |

## Other

- **Enumeration date:** 07/27/2006
- **Last updated:** 01/19/2012