Provider Demographics
NPI:1841651098
Name:COLEMAN, MICHELLE SHERRIE
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SHERRIE
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 1:2708 BOB WHITE COURT
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815
Mailing Address - Country:US
Mailing Address - Phone:706-832-3331
Mailing Address - Fax:888-654-3589
Practice Address - Street 1:2708 BOB WHITE COURT
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815
Practice Address - Country:US
Practice Address - Phone:706-832-3331
Practice Address - Fax:888-654-3589
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16020070374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide