Provider Demographics
NPI:1134157381
Name:COLEMAN, WILLIAM EDWIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWIN
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 WILDFAIR RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9362
Mailing Address - Country:US
Mailing Address - Phone:229-894-7067
Mailing Address - Fax:
Practice Address - Street 1:1211 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1935
Practice Address - Country:US
Practice Address - Phone:229-432-9746
Practice Address - Fax:229-883-4484
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC142052084A0401X
FLME00666262084A0401X
GA0315772084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000463526IMedicaid
GA000463526HMedicaid
GAE32715Medicare UPIN
GA000463526HMedicaid