Provider Demographics
NPI:1770565459
Name:COLEMAN, ANDREW CLARK (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CLARK
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:CLARK
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:305 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4579
Mailing Address - Country:US
Mailing Address - Phone:731-642-0025
Mailing Address - Fax:731-644-0899
Practice Address - Street 1:305 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4579
Practice Address - Country:US
Practice Address - Phone:731-642-0025
Practice Address - Fax:731-644-0899
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110204548OtherRAILROAD MEDICARE
TN3835883Medicaid
TN3835883Medicaid
TN3835884Medicare ID - Type UnspecifiedMEDICAER PROVIDER #