Provider Demographics
NPI:1144260274
Name:COFFEY, MARK F (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:F
Last Name:COFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 HWY. 21 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326
Mailing Address - Country:US
Mailing Address - Phone:912-295-2133
Mailing Address - Fax:912-295-5924
Practice Address - Street 1:5629 HWY. 21 SOUTH
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-295-2133
Practice Address - Fax:912-295-5924
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27447207P00000X
GA051450207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG51450Medicaid
GA000948813DMedicaid
GA0100948813CMedicaid
GA000948813BMedicaid
GA000948813AMedicaid
SC000948813FMedicaid
GA10058598OtherAMERIGROUP
GA000948813DMedicaid
SC000948813FMedicaid
GA000948813BMedicaid
GA93BDQWKMedicare PIN
SCP00187163Medicare PIN