Provider Demographics
NPI:1881786903
Name:COETZEE, ELIZABETH JANE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:COETZEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3965 CARRIAGE GATE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5444
Mailing Address - Country:US
Mailing Address - Phone:770-623-3004
Mailing Address - Fax:770-623-3285
Practice Address - Street 1:9200 MARNE ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-3711
Practice Address - Fax:706-544-2144
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA026243146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant