Healthcare Provider Details

I. General information

NPI: 1972090033
Provider Name (Legal Business Name): AUBREY MARIE COLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY MARIE THYEN

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E BARBOUR ST
EUFAULA AL
36027-1603
US

IV. Provider business mailing address

126 CLINIC DR
DOTHAN AL
36303-1980
US

V. Phone/Fax

Practice location:
  • Phone: 334-619-0940
  • Fax: 334-689-5200
Mailing address:
  • Phone: 334-793-1881
  • Fax: 334-712-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38601
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier264676
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier110571500
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 3
Identifier003250069B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier110571500
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: