Provider Demographics
NPI:1861445215
Name:LOGAN, SHARON COFFIELD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:COFFIELD
Last Name:LOGAN
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 1:3647 J DEWEY GRAY CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2205
Mailing Address - Country:US
Mailing Address - Phone:706-504-9712
Mailing Address - Fax:706-504-9703
Practice Address - Street 1:3647 J DEWEY GRAY CIR STE 200
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2205
Practice Address - Country:US
Practice Address - Phone:706-504-9712
Practice Address - Fax:706-504-9703
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4536363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ69519Medicare UPIN
GA97WCHPMMedicare PIN
GA863016010AMedicaid