Provider Demographics
NPI:1982682746
Name:COATES, JAY E JR
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:COATES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3196 S MARYLAND PKWY STE 425
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2318
Practice Address - Country:US
Practice Address - Phone:725-205-0725
Practice Address - Fax:725-204-5251
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79259208600000X
NV9812086S0102X, 208600000X, 2086S0127X, 2086S0127X
MS283702086S0127X
NC2020-040652086S0127X
VA01022063702086S0127X, 2086S0127X
TN41582086S0127X
SCDO833702086S0127X
TXT00682086S0127X
CODR.00651482086S0127X
IDO-12982086S0127X
FLOS173292086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018500Medicaid
NV1900066OtherFIRST HEALTH/CCN
NV707531OtherAHCCCS
NV211661OtherMEDICAID - WASHINGTON ST
NV880330858OtherANTHEM BC/BS
NV880330858OtherSIERRA HEALTH SERVICES
NV64530574OtherMEDICAID - MEXICO
NVXPY206356OtherMEDI-CAL
NV020052271OtherMEDICARE RR
NV880330858OtherAFFILIATED HEALTH FUNDS
NV880330858OtherCIGNA
NV880330858OtherHORIZON HEALTH/MCC
NV880330858OtherBEECH STREET
NV880330858OtherCHOICE CARE/HUMANA
NV880330858OtherGREAT-WEST
NV880330858OtherPACIFICARE
NVAZ0000047OtherCALOPTIMA
NVH48800Medicare UPIN
NV002018500Medicaid