Organization
EAR, NOSE AND THROAT CLINIC OF COFFEE CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMBER PATTERSON (OFFICE MANAGER)
(912) 384-2200
Entity
Organization
Contact information
Practice address
312 WESTSIDE DRIVE, DOUGLAS, GA 31533-0312
(912) 384-2200
(912) 383-7992
Mailing address
P.O. BOX 1068, DOUGLAS, GA 31533-1068
(912) 384-2200
(912) 383-7992
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
041953
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300032501A
—
GA
01
—
990001864
MEDICARE RAILROAD
GA
01
—
DE8251
MEDICARE RAILROAD GROUP ID
GA
Enumeration date
04/20/2006
Last updated
02/04/2010
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