Provider Demographics
NPI:1356481030
Name:COFFEY, BENJAMIN SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:COFFEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0294
Mailing Address - Country:US
Mailing Address - Phone:423-745-2500
Mailing Address - Fax:423-745-2571
Practice Address - Street 1:500 DECATUR PIKE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2514
Practice Address - Country:US
Practice Address - Phone:423-745-2500
Practice Address - Fax:423-745-2571
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH44775Medicare UPIN
TN3307306Medicare ID - Type Unspecified