Healthcare Provider Details

I. General information

NPI: 1770534570
Provider Name (Legal Business Name): MR. SEAN C COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 CHATTANOOGA AVE
DALTON GA
30720-2637
US

IV. Provider business mailing address

1436 CHATTANOOGA AVE
DALTON GA
30720-2637
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-2142
  • Fax: 706-226-1771
Mailing address:
  • Phone: 706-226-2142
  • Fax: 706-226-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number049726
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number049726
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: