Individual
KELLY MARCUS COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6300 E LAKE BLVD STE 201, VANCLEAVE, MS 39565-6771
(228) 230-2663
(228) 546-3257
Mailing address
6300 E LAKE BLVD STE 301, VANCLEAVE, MS 39565-6771
(228) 230-2663
(228) 546-3257
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
25293
MS
208VP0014X
Interventional Pain Medicine Physician
Primary
25293
MS
Other
Enumeration date
05/04/2010
Last updated
09/14/2018
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