Healthcare Provider Details

I. General information

NPI: 1447667183
Provider Name (Legal Business Name): SANDY ANDERSON COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 GORDON RD
JASPER GA
30143-7104
US

IV. Provider business mailing address

51 GORDON RD
JASPER GA
30143-7104
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-9768
  • Fax: 706-692-4040
Mailing address:
  • Phone: 706-692-9768
  • Fax: 706-692-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN123413
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: