Provider Demographics
NPI:1225383938
Name:COE, KATHERINE JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JEAN
Last Name:COE
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 1:2900 CHAMBLEE TUCKER RD BLDG 16
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4148
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD BLDG 16
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4148
Practice Address - Country:US
Practice Address - Phone:770-939-1288
Practice Address - Fax:770-212-2203
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPA9657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003250592AMedicaid