Individual
COLEMAN S FRAVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3 RICHLAND MEDICAL PARK DR STE 310, COLUMBIA, SC 29203
(803) 434-8323
(803) 434-8326
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
552
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0089PA
—
SC
Enumeration date
09/01/2006
Last updated
09/06/2018
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