Healthcare Provider Details

I. General information

NPI: 1396194718
Provider Name (Legal Business Name): JOSHUA DAVID COLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

131 BROAD ST APT B
AUGUSTA GA
30901-1551
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-0211
  • Fax:
Mailing address:
  • Phone: 706-726-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number008258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: