Provider Demographics
NPI:1750378915
Name:COLEMAN, REGINA NEPOMUCENO (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:NEPOMUCENO
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:NEPOMUCENO
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:204 SHAVER DR
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8552
Mailing Address - Country:US
Mailing Address - Phone:423-581-7040
Mailing Address - Fax:423-581-9563
Practice Address - Street 1:204 SHAVER DR
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8552
Practice Address - Country:US
Practice Address - Phone:423-581-7040
Practice Address - Fax:423-581-9563
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29081208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3839137Medicaid
TN3839137Medicaid