Basic Information
Provider Information
NPI: 1275572588
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLEMAN
FirstName: WILLIAM
MiddleName: ARMSTRONG
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 INDEPENDENCE PT
Address2: STE 212
City: GREENVILLE
State: SC
PostalCode: 296154536
CountryCode: US
TelephoneNumber: 8647976044
FaxNumber:  
Practice Location
Address1: 890 W FARIS RD
Address2: STE 470
City: GREENVILLE
State: SC
PostalCode: 296054253
CountryCode: US
TelephoneNumber: 8644551600
FaxNumber: 8644553095
Other Information
ProviderEnumerationDate: 06/05/2006
LastUpdateDate: 11/18/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X9306SCY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
APPROVED05SC MEDICAID


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