Provider Demographics
NPI:1770512303
Name:COLEMAN, AMY BALL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BALL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
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 5653
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5653
Mailing Address - Country:US
Mailing Address - Phone:601-485-1015
Mailing Address - Fax:601-693-9314
Practice Address - Street 1:1203 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3926
Practice Address - Country:US
Practice Address - Phone:601-485-1015
Practice Address - Fax:601-693-9314
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS149392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121946Medicaid
MS512G700091OtherMEDICARE GROUP
MS00121946Medicaid
MSG98002Medicare UPIN