Provider Demographics
NPI:1104691476
Name:COFFMAN, MARY VIRGINIA (MS, CNS, LDN, LN)
Entity type:Individual
Prefix:
First Name:MARY VIRGINIA
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:MS, CNS, LDN, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E CLUB LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1132
Mailing Address - Country:US
Mailing Address - Phone:404-919-0602
Mailing Address - Fax:404-467-4167
Practice Address - Street 1:1110 E CLUB LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1132
Practice Address - Country:US
Practice Address - Phone:404-919-0602
Practice Address - Fax:404-467-4167
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education