Healthcare Provider Details

I. General information

NPI: 1083296321
Provider Name (Legal Business Name): JAMIAN COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 CHURCH ST
DECATUR GA
30030-2515
US

IV. Provider business mailing address

3350 BRECKINRIDGE BLVD STE 200
DULUTH GA
30096-4959
US

V. Phone/Fax

Practice location:
  • Phone: 404-589-9040
  • Fax:
Mailing address:
  • Phone: 404-589-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: