Provider Demographics
NPI:1508485178
Name:COLEMAN, SETH LEWIS (PA)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:LEWIS
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 STELLA RUTH RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-8501
Mailing Address - Country:US
Mailing Address - Phone:731-571-0479
Mailing Address - Fax:
Practice Address - Street 1:123 COMMONS DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3882
Practice Address - Country:US
Practice Address - Phone:731-661-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant