Healthcare Provider Details

I. General information

NPI: 1467396960
Provider Name (Legal Business Name): KYLER A COLBERT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LENOX POINTE NE STE A
ATLANTA GA
30324-3103
US

IV. Provider business mailing address

50 LENOX POINTE NE STE A
ATLANTA GA
30324-3103
US

V. Phone/Fax

Practice location:
  • Phone: 678-824-6590
  • Fax:
Mailing address:
  • Phone: 678-824-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: