Provider Demographics
NPI:1437819182
Name:SMITH, COLEMAN (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KENNERLY WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8644
Mailing Address - Country:US
Mailing Address - Phone:916-934-6567
Mailing Address - Fax:
Practice Address - Street 1:130 KENNERLY WAY
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8644
Practice Address - Country:US
Practice Address - Phone:916-934-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date: