Individual
DARRIN COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 882-1411
Mailing address
1S450 SUMMIT AVE STE 165, OAKBROOK TERRACE, IL 60181-3952
(630) 320-6871
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
008965
GA
363A00000X
Physician Assistant
Primary
085009366
IL
Other
Enumeration date
09/18/2018
Last updated
01/06/2023
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