Provider Demographics
NPI:1922980556
Name:COGGINS, KRISTINA SARAHMAE (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SARAHMAE
Last Name:COGGINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 GORDON ST APT B
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-1521
Mailing Address - Country:US
Mailing Address - Phone:678-416-3398
Mailing Address - Fax:
Practice Address - Street 1:222 GORDON ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-1519
Practice Address - Country:US
Practice Address - Phone:770-537-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13204207QA0505X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine