Provider Demographics
NPI:1063867455
Name:COLEMAN, SUSAN (RRA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 CARTLEDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOX SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31801
Mailing Address - Country:US
Mailing Address - Phone:706-571-1054
Mailing Address - Fax:706-571-1093
Practice Address - Street 1:7023 CARTLEDGE ROAD
Practice Address - Street 2:
Practice Address - City:BOX SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31801
Practice Address - Country:US
Practice Address - Phone:706-571-1054
Practice Address - Fax:705-571-1093
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN417893243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant