Healthcare Provider Details

I. General information

NPI: 1679647507
Provider Name (Legal Business Name): ALCENIA COLEMAN RN, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6728 CHESEPEAKE TRL
REX GA
30273-2229
US

IV. Provider business mailing address

PO BOX 258
MORROW GA
30260-0258
US

V. Phone/Fax

Practice location:
  • Phone: 404-664-6183
  • Fax:
Mailing address:
  • Phone: 404-664-6183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN163373
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN163373
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License NumberRN163373
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberRN163373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: