Provider Demographics
NPI:1750795373
Name:COLEMAN, CAITLYN SMITH (MD)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:SMITH
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0245
Mailing Address - Country:US
Mailing Address - Phone:912-530-7337
Mailing Address - Fax:912-530-7339
Practice Address - Street 1:391 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0245
Practice Address - Country:US
Practice Address - Phone:912-530-7337
Practice Address - Fax:912-530-7339
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL37032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics