Provider Demographics
NPI:1548306525
Name:COLEMAN, CHARLOTTE DENIECE (MD)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:DENIECE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5990 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38075
Mailing Address - Country:US
Mailing Address - Phone:731-254-9160
Mailing Address - Fax:
Practice Address - Street 1:295 SUMMAR AVENUE
Practice Address - Street 2:WEST TENNESSE REGIONAL OFFICE
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-423-6600
Practice Address - Fax:731-935-7093
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN252832083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30733Medicare UPIN