Provider Demographics
NPI:1972090033
Name:COLEMAN, AUBREY MARIE (MD)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:MARIE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:MARIE
Other - Last Name:THYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1980
Mailing Address - Country:US
Mailing Address - Phone:334-793-1881
Mailing Address - Fax:334-712-1815
Practice Address - Street 1:323 E BARBOUR ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1603
Practice Address - Country:US
Practice Address - Phone:334-619-0940
Practice Address - Fax:334-689-5200
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38601208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL264676Medicaid
FL110571500Medicaid
GA003250069BMedicaid