Provider Demographics
NPI:1396795241
Name:COFRANCESCO, SIMON ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:ROBERT
Last Name:COFRANCESCO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3005
Mailing Address - Country:US
Mailing Address - Phone:404-446-0600
Mailing Address - Fax:404-446-0601
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3005
Practice Address - Country:US
Practice Address - Phone:404-446-0600
Practice Address - Fax:404-446-0601
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS13873207RG0100X
GA62826207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114101Medicaid
GA202I108222OtherMEDICARE PTAN
MS00114101Medicaid
GA202I108222OtherMEDICARE PTAN