=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720163868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY GILREATH COLEMAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 05/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 WASHINGTON ST SE
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30501-3619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-532-9250
-----------------------------------------------------
Fax | 770-532-4242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2511
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30503-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-532-9250
-----------------------------------------------------
Fax | 770-532-4242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 046837
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------