Healthcare Provider Details

I. General information

NPI: 1366361560
Provider Name (Legal Business Name): JAMYIAH LAQUAN COACHMAN CNM,WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 UPPER RIVERDALE RD SW
RIVERDALE GA
30274-2616
US

IV. Provider business mailing address

1240 W PEACHTREE ST NW APT 2313
ATLANTA GA
30309-4747
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-6010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104884213
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM10879
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: