Provider Demographics
NPI:1093003923
Name:COLEMAN, DEBORAH CARLTON (MED SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CARLTON
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LIVE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-1670
Mailing Address - Country:US
Mailing Address - Phone:478-274-9138
Mailing Address - Fax:
Practice Address - Street 1:517 LIVE OAK WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-1670
Practice Address - Country:US
Practice Address - Phone:478-274-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09138425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist