Healthcare Provider Details

I. General information

NPI: 1154528982
Provider Name (Legal Business Name): MICHAEL TROY COLEMAN RPA RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 YANCEYVILLE ST
GREENSBORO NC
27405-6962
US

IV. Provider business mailing address

1414 YANCEYVILLE ST
GREENSBORO NC
27405-6962
US

V. Phone/Fax

Practice location:
  • Phone: 336-895-1598
  • Fax: 336-390-2170
Mailing address:
  • Phone: 336-895-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number231751
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number02 TN 1039
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: