Provider Demographics
NPI:1386639284
Name:COLEMAN, MARLA O (D D S)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:O
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2962
Mailing Address - Country:US
Mailing Address - Phone:404-523-3153
Mailing Address - Fax:404-523-0136
Practice Address - Street 1:970 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:SUITE 301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2962
Practice Address - Country:US
Practice Address - Phone:404-523-3153
Practice Address - Fax:404-523-0136
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-01-03
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
GAGA103071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00364823AMedicaid