Provider Demographics
NPI:1578751038
Name:COKER, LUCYNDA R (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:LUCYNDA
Middle Name:R
Last Name:COKER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:LUCYNDA
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 2035
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-351-5983
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 2035
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-351-5983
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA165700364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA320485936GMedicaid
GA202I502091Medicare PIN