Provider Demographics
NPI:1629456694
Name:COFFEE, ANNSLEY MATHEWS (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNSLEY
Middle Name:MATHEWS
Last Name:COFFEE
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 1:312 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3530
Mailing Address - Country:US
Mailing Address - Phone:912-384-2200
Mailing Address - Fax:912-383-7992
Practice Address - Street 1:312 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3530
Practice Address - Country:US
Practice Address - Phone:912-384-2200
Practice Address - Fax:912-383-7992
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7564363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical