Healthcare Provider Details

I. General information

NPI: 1750622379
Provider Name (Legal Business Name): JACQUELINE WHEELER-COLEMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 TWIN CIRCLE DR
NASHVILLE TN
37217-4067
US

IV. Provider business mailing address

1108 TWIN CIRCLE DR
NASHVILLE TN
37217-4067
US

V. Phone/Fax

Practice location:
  • Phone: 615-394-3362
  • Fax:
Mailing address:
  • Phone: 615-394-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number24888
License Number StateTN

VIII. Authorized Official

Name: DR. JACQUELINE WHEELER-COLEMAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 615-394-3362