Healthcare Provider Details

I. General information

NPI: 1982913463
Provider Name (Legal Business Name): DEBORAH BOOHER KOLB, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8371 HIGHWAY 72 W SUITE 200
MADISON AL
35758-9505
US

IV. Provider business mailing address

8371 HIGHWAY 72 W SUITE 200
MADISON AL
35758-9505
US

V. Phone/Fax

Practice location:
  • Phone: 256-722-0664
  • Fax: 256-722-0285
Mailing address:
  • Phone: 256-722-0664
  • Fax: 256-722-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH BOOHER KOLB
Title or Position: OWNER
Credential: M.D.
Phone: 256-722-0664