Provider Demographics
NPI:1760624332
Name:COKER, NEYSA ALICE (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:NEYSA
Middle Name:ALICE
Last Name:COKER
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-422-7630
Mailing Address - Fax:770-422-6017
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 140
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-422-7630
Practice Address - Fax:770-422-6017
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0141101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA404268068Medicaid