Healthcare Provider Details

I. General information

NPI: 1134157381
Provider Name (Legal Business Name): WILLIAM EDWIN COLEMAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 PALMYRA RD
ALBANY GA
31701-1935
US

IV. Provider business mailing address

3027 WILDFAIR RD
ALBANY GA
31721-9362
US

V. Phone/Fax

Practice location:
  • Phone: 229-432-9746
  • Fax: 229-883-4484
Mailing address:
  • Phone: 229-894-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number14205
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME0066626
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number031577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: