Provider Demographics
NPI:1588858971
Name:JOSHUA A. COLEMAN
Entity Type:Organization
Organization Name:JOSHUA A. COLEMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-644-9180
Mailing Address - Street 1:715 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4296
Mailing Address - Country:US
Mailing Address - Phone:731-644-9180
Mailing Address - Fax:731-642-9180
Practice Address - Street 1:715 MORTON STREET
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4210
Practice Address - Country:US
Practice Address - Phone:731-644-9180
Practice Address - Fax:731-642-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002395261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMCO839970OtherDEANUMBER