Wallace Coleman

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC010234 Issued in GA

Practice address

2403 Osler Court
Suite B
Albany, GA 31707

Phone

(229) 639-3135

NPI assigned

Nov 15, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wallace.coleman@aaphc.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Albany Area Primary Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1780608992

  GA

  Medicare reassignment NPD
• Albany Area Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1013709625
  NPD
• Albany Area Primary Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, GA
  • NPI 1164888491
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1669941035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 N WESTOVER BLVD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317072983",
            "telephone_number": "229-888-6559",
            "fax_number": "229-436-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 OSLER COURT",
            "address_2": "SUITE B",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "31707",
            "telephone_number": "229-639-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "WALLACE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-15",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC010234",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC010234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark D Cohen, M.D.
• Charles R Cole, NP
• Cherokee Cole, RN
• Amanda M Coleman, PA-C
• Michael John Coleman, M.D.
• William Edwin Coleman Jr., M.D.
• Will Coley, PHARM D
• Purvis Collier, P.A.
• Chappell A Collins Jr., M.D.
• Lisa Melanie Collins, RD, LD

• All providers in Albany, GA
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.