Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 060360 | GA |
N | 2080P0204X | Pediatric Emergency Doctor | MD00043043 | WA |
NPI | 1548346224 |
---|---|
Provider Name | Brian H. Coleman |
First Address | Savannah, GA 31416-0428 |
Second Address | Savannah, GA 31404-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01170543 | AMERIGROUP (01) | GA |
1548346224 | PEACHSTATE HEALTH PLAN (01) | GA |
222775448A | (05) | GA |
295110 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8424723 | (05) | WA |
G60361 | (05) | SC |
I30906 | (02) | |
N426895 | NONPAR WELLCARE (01) | GA |