Provider Demographics
NPI:1275893414
Name:COLEMAN, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CONTINENTAL PL
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1041
Mailing Address - Country:US
Mailing Address - Phone:877-977-4630
Mailing Address - Fax:888-242-7469
Practice Address - Street 1:103 CONTINENTAL PL
Practice Address - Street 2:SUITE 405
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1041
Practice Address - Country:US
Practice Address - Phone:877-977-4630
Practice Address - Fax:888-242-7469
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist