Provider Demographics
NPI:1194967349
Name:COLEMAN, SHELLI I (DO)
Entity type:Individual
Prefix:DR
First Name:SHELLI
Middle Name:I
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-6002
Mailing Address - Country:US
Mailing Address - Phone:662-862-7047
Mailing Address - Fax:662-862-7053
Practice Address - Street 1:302 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-6002
Practice Address - Country:US
Practice Address - Phone:662-862-7047
Practice Address - Fax:662-862-7053
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine