Field 2: BILLING SERVICE NAME If applicable, enter the name of the billing service that the provider is enrolled. with. If you are not using a billing service, leave this field blank. Field 3: DATE Enter the date the Certification Statement is submitted to the fiscal agent.
Gregory Jerome Coleman (born September 9, 1954 in Jacksonville, Florida) is a retired American football punter who had a 12-year career in the National Football League playing for the Cleveland Browns, the Minnesota Vikings, and the Washington Redskins. He attended Florida A&M University.
For the American basketball coach, see Greg White (basketball coach). Stylez G. White (born Gregory Alphonso White, Jr. on July 25, 1979) is a former American football defensive end. He was drafted by the Houston Texans in the seventh round of the 2002 NFL Draft. He played college football at Minnesota. White was also a member of the Minnesota Vikings, Atlanta Falcons, Tennessee Titans, New Orleans Saints, Washington Redskins, Chicago Bears, Tampa Bay Buccaneers, and Orlando Predators.