Provider Demographics
NPI:1306845490
Name:COLEMAN, MARIA TERESA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA TERESA
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA TERESA
Other - Middle Name:B
Other - Last Name:ANGELES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:236 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1106
Mailing Address - Country:US
Mailing Address - Phone:770-478-9240
Mailing Address - Fax:770-478-0318
Practice Address - Street 1:236 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1106
Practice Address - Country:US
Practice Address - Phone:770-478-9240
Practice Address - Fax:770-478-0318
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00973332AMedicaid
GA00973332AMedicaid