MEDICARE: MS. ALGEM COLEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC007704	GA

General Provider Information

NPI Number	:	1184027377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALGEM COLEMAN

Provider Business Mailing Address
First Line	:	277 N. HIGHWAY 74
Second Line	:	SUITE 306
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30213-4274
Country	:	US
Telephone Number	:	678-383-1210
Fax Number	:

Provider Business Practice Location Address
First Line	:	277 N. HIGHWAY 74
Second Line	:	SUITE 306
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30213-4274
Country	:	US
Telephone Number	:	678-383-1210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	10/25/2018

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