MEDICARE: CARLA J COLEMAN REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN229541	GA
2	163WH0200X	Home Health Registered Nurse	RN229541	GA

General Provider Information

NPI Number	:	1659717528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA J COLEMAN REGISTERED NURSE

Provider Business Mailing Address
First Line	:	3477 MUSTANG DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2127
Country	:	US
Telephone Number	:	770-369-4707
Fax Number	:

Provider Business Practice Location Address
First Line	:	3477 MUSTANG DR
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2127
Country	:	US
Telephone Number	:	770-369-4707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	05/17/2013

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