Healthcare Provider Details

I. General information

NPI: 1295663391
Provider Name (Legal Business Name): JULIA E COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 LAKE DR MIDWAY GA 31320
MIDWAY GA
31320
US

IV. Provider business mailing address

1494 LAKE DR MIDWAY GA 31320
MIDWAY GA
31320
US

V. Phone/Fax

Practice location:
  • Phone: 423-384-2487
  • Fax:
Mailing address:
  • Phone: 423-384-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: