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General NPI Number Information
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NPI Number | 1629483607
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Entity Type | Individual
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Provider Name | JERRY COLEMAN II N.P
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Gender | Male
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 06/27/2014
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Provider Practice Location Address
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Address Line | 2305 CHAMBLISS AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3847
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Country | US
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Telephone | 423-559-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 CHAMBLISS AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3847
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Country | US
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Telephone | 423-559-6000
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 18803
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License Number State | TN
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