Individual provider Active NPI

Marilyn Joy Coleman, M.D.

  • Pediatrics Physician
  • Carrollton, GA
National Provider Identifier
1821071093
Registry record updated Jun 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
056034 Issued in GA
Practice address
804 Dixie St
Carrollton, GA 30117-4416
Phone
(770) 834-0606
Fax
(770) 834-1833
NPI assigned
Nov 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 056034 GA Primary

Addresses

Primary practice location

804 Dixie St
Carrollton, GA 30117-4416

Mailing address

119 Ambulance Dr
Suite 202
Carrollton, GA 30117-3857
Phone (770) 834-0606

Other identifiers 1

IdentifierTypeStateIssuer
698666059CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240815003717 GA Practitioner - Pediatric Medicine 9133213507 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
056034GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc Pediatrics CurrentSince Aug 1, 2024 Accepting new patients
TMC Children's Healthcare of West Georgia PastSince Aug 1, 2024 Accepting new patients

Locations

100 Greenway Blvd
Fl 2
Carrollton, GA 30117
Phone (770) 838-8710

119 Ambulance Dr
Ste 202
Carrollton, GA 30117
Phone (770) 838-8710

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

706 Dixie St
Ste 210
Carrollton, GA 30117
Phone (770) 812-8640

804 Dixie St
Carrollton, GA 30117
Phone (770) 834-0606

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1821071093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DR",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173857",
            "telephone_number": "770-834-0606",
            "fax_number": "770-834-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174416",
            "telephone_number": "770-834-0606",
            "fax_number": "770-834-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "MARILYN",
        "middle_name": "JOY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "056034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "698666059C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.