Provider Demographics
NPI:1902218969
Name:COFFMAN, GREGORY JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JUSTIN
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 HOSPITAL BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4918
Mailing Address - Country:US
Mailing Address - Phone:770-410-4661
Mailing Address - Fax:770-410-4664
Practice Address - Street 1:2500 HOSPITAL BLVD STE 290
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4918
Practice Address - Country:US
Practice Address - Phone:770-410-4661
Practice Address - Fax:770-410-4664
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2019-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA78892208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery