Healthcare Provider Details

I. General information

NPI: 1639804537
Provider Name (Legal Business Name): OLIVIA FRANCIS COLEMAN-SCRUGGS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA FRANCIS COLEMAN

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 PLAZA AVE
MEMPHIS TN
38111-4614
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 901-730-4204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5768
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5768
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: