Provider Demographics
NPI:1467242701
Name:COFFEY PLLC
Entity type:Organization
Organization Name:COFFEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEN
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-668-9981
Mailing Address - Street 1:125 FORESTVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-1100
Mailing Address - Country:US
Mailing Address - Phone:601-668-9981
Mailing Address - Fax:
Practice Address - Street 1:119 COLONY CROSSING WAY STE 780
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6327
Practice Address - Country:US
Practice Address - Phone:769-300-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty