Healthcare Provider Details

I. General information

NPI: 1376648758
Provider Name (Legal Business Name): COLIN E RAMIREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CARLTON ST UNIVERSITY HEALTH CENTER
ATHENS GA
30602-1503
US

IV. Provider business mailing address

55 CARLTON ST UNIVERSITY HEALTH CENTER
ATHENS GA
30602-1503
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-8654
  • Fax: 706-583-0393
Mailing address:
  • Phone: 706-542-8654
  • Fax: 706-583-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101043189
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number72423
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: