Provider Demographics
NPI:1881033124
Name:COLEMAN, ELIZABETH BERNICE (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BERNICE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BERNICE
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, FNP-C
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-287-3815
Practice Address - Fax:770-287-9689
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176064363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003135123BMedicaid
GA904860OtherWELLCARE
GA003135123AMedicaid
GA003135123DMedicaid
GA003135123HMedicaid
GA003135123LMedicaid
GA003135123IMedicaid
GA01879953OtherAMERIGROUP
GA202I428873OtherMEDICARE
GA003135123KMedicaid
GA003135123MMedicaid
GA003135123CMedicaid
GA003135123JMedicaid