Provider Demographics
NPI:1164457180
Name:COLEMAN, CHARLES HAMILTON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HAMILTON
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3346
Mailing Address - Country:US
Mailing Address - Phone:706-722-0705
Mailing Address - Fax:762-333-0496
Practice Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3346
Practice Address - Country:US
Practice Address - Phone:706-722-0705
Practice Address - Fax:762-333-0496
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18633208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00153271B2Medicaid
GA00153271B2Medicaid
D39623Medicare UPIN