Provider Demographics
NPI:1649441635
Name:COLEMAN, TAYONA LASALLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TAYONA
Middle Name:LASALLE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TAYONA
Other - Middle Name:LASALLE
Other - Last Name:DAUGHTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1053 CROWN LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8717
Mailing Address - Country:US
Mailing Address - Phone:678-583-1316
Mailing Address - Fax:678-583-1316
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse