Healthcare Provider Details

I. General information

NPI: 1114758273
Provider Name (Legal Business Name): JAMIE COLEMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 ALICE ST
WAYCROSS GA
31501-5216
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 912-285-1140
  • Fax:
Mailing address:
  • Phone: 855-963-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP304238
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP304238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: