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General NPI Number Information
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NPI Number | 1508485178
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Entity Type | Individual
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Provider Name | SETH LEWIS COLEMAN PA
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Gender | Male
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 123 COMMONS DR
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City | MARTIN
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State | TN
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Zip | 38237-3882
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Country | US
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Telephone | 731-661-9825
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Fax |
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Provider Business Mailing Address
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Address Line | 134 STELLA RUTH RD
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City | MARTIN
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State | TN
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Zip | 38237-8501
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Country | US
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Telephone | 731-571-0479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4635
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License Number State | TN
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