Provider Demographics
NPI:1982062642
Name:COLEMAN, ANDREW (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4749 FULMAR DR
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3334
Mailing Address - Country:US
Mailing Address - Phone:615-854-1828
Mailing Address - Fax:
Practice Address - Street 1:205 MARENGO ST.
Practice Address - Street 2:ELIZA COFFEE MEMORIAL HOSPITAL
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35636
Practice Address - Country:US
Practice Address - Phone:256-768-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant