Provider Demographics
NPI:1578081808
Name:COFFER, MARQUETA A
Entity Type:Individual
Prefix:
First Name:MARQUETA
Middle Name:A
Last Name:COFFER
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 1:1380 BROCKETT PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-3044
Mailing Address - Country:US
Mailing Address - Phone:404-838-6662
Mailing Address - Fax:
Practice Address - Street 1:1380 BROCKETT PL
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021
Practice Address - Country:US
Practice Address - Phone:404-838-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator