1528307139 NPI number — DR. WELLINGTON JOHN COLEMAN JR. PH.D.

Table of content: DR. WELLINGTON JOHN COLEMAN JR. PH.D. (NPI 1528307139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528307139 NPI number — DR. WELLINGTON JOHN COLEMAN JR. PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
WELLINGTON
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLEMAN
Provider Other First Name:
WELLINGTON
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
PH.D, RN, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528307139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3308 TULANE AVE SUITE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-354-2090
Provider Business Mailing Address Fax Number:
504-354-2090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 ELYSIAN FIELDS AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70122-7400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-813-1283
Provider Business Practice Location Address Fax Number:
504-246-2373
Provider Enumeration Date:
02/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LA.2651 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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