Provider Demographics
NPI:1548346224
Name:COLEMAN, BRIAN H
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:H
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13428
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0428
Mailing Address - Country:US
Mailing Address - Phone:912-350-3849
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000430432080P0204X
GA060360207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8424723Medicaid
GAN426895OtherNONPAR WELLCARE
295110OtherINTERNAL ID-MOTOR VEHICLE ID
GA01170543OtherAMERIGROUP
GA222775448AMedicaid
SCG60361Medicaid
GA1548346224OtherPEACHSTATE HEALTH PLAN
GA01170543OtherAMERIGROUP
GAN426895OtherNONPAR WELLCARE
GA511I370045Medicare PIN