Provider Demographics
NPI:1437817194
Name:COFIELD, MONICA RENEE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:COFIELD
Suffix:
Gender:F
Credentials:
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 821
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30112-0016
Mailing Address - Country:US
Mailing Address - Phone:678-571-8980
Mailing Address - Fax:
Practice Address - Street 1:108 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8425
Practice Address - Country:US
Practice Address - Phone:678-571-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN0775695
GALPN075695