Provider Demographics
NPI:1447971528
Name:COLEMAN, DOROTHY (CEO)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CEO
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 1355
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-0027
Mailing Address - Country:US
Mailing Address - Phone:770-758-0080
Mailing Address - Fax:770-775-7760
Practice Address - Street 1:169 DEMPSEY AVE STE 2A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-2019
Practice Address - Country:US
Practice Address - Phone:770-758-0080
Practice Address - Fax:770-775-7760
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health