Provider Demographics
NPI:1932438421
Name:COLEMAN, CHAKOSHA LANCE (MSPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHAKOSHA
Middle Name:LANCE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:MISS
Other - First Name:CHAKOSHA
Other - Middle Name:L
Other - Last Name:LANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPAS, PA-C
Mailing Address - Street 1:2893 STURGIS RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-6607
Mailing Address - Country:US
Mailing Address - Phone:803-366-9090
Mailing Address - Fax:803-366-9141
Practice Address - Street 1:2893 STURGIS RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-6607
Practice Address - Country:US
Practice Address - Phone:803-366-9090
Practice Address - Fax:803-366-9141
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant