Provider Demographics
NPI:1700557204
Name:COLEMAN, MARIA ALESSANDRA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALESSANDRA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 HIGHTOWER TRL STE D101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6207
Mailing Address - Country:US
Mailing Address - Phone:678-306-6260
Mailing Address - Fax:
Practice Address - Street 1:1215 HIGHTOWER TRL STE D101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6207
Practice Address - Country:US
Practice Address - Phone:678-379-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist