Provider Demographics
NPI:1679647507
Name:COLEMAN, ALCENIA (RN, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALCENIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-0258
Mailing Address - Country:US
Mailing Address - Phone:404-664-6183
Mailing Address - Fax:
Practice Address - Street 1:6728 CHESEPEAKE TRL
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2229
Practice Address - Country:US
Practice Address - Phone:404-664-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163373163WC0400X, 163WM0102X, 163WP1700X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA785298162AMedicaid