Provider Demographics
NPI:1588498356
Name:COFFEE, EMORY REID (LMT)
Entity type:Individual
Prefix:
First Name:EMORY
Middle Name:REID
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MUKTI
Other - Middle Name:REID
Other - Last Name:FORRESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2998 KATHERINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5827
Mailing Address - Country:US
Mailing Address - Phone:678-612-4692
Mailing Address - Fax:
Practice Address - Street 1:1924 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3438
Practice Address - Country:US
Practice Address - Phone:678-901-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist