Provider Demographics
NPI:1336239441
Name:COLEMAN, MARCHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCHELLE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
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 936535
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 GLEN ECHO RD STE 111
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2857
Practice Address - Country:US
Practice Address - Phone:615-657-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1740363A00000X, 363AS0400X
IN10000561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371161Medicaid
TN1517499Medicaid
MS7187860Medicaid
TN620819926OtherCIGNA
IN259950OtherMEDICARE PART B
TN620819926OtherAETNA
TN620819926OtherTRICARE
IN177280B3OtherMEDICARE NUMBER
AR110318002Medicaid
INP48087Medicare UPIN
TN620819926OtherCIGNA
IN259950OtherMEDICARE PART B
TN3371161Medicaid