Provider Demographics
NPI:1487021911
Name:COAXUM, SALEMA (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:SALEMA
Middle Name:
Last Name:COAXUM
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 TOWN PARK LN STE 300
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3477
Mailing Address - Country:US
Mailing Address - Phone:706-210-8855
Mailing Address - Fax:706-432-8775
Practice Address - Street 1:1202 TOWN PARK LN STE 300
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3477
Practice Address - Country:US
Practice Address - Phone:706-210-8855
Practice Address - Fax:706-432-8775
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV826486363LP0808X, 363LP0808X
GARN200458363LP0808X, 163W00000X
NC5011616363LP0808X
COAPN.0997838-NP363LP0808X
CA95024000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse