Healthcare Provider Details

I. General information

NPI: 1144208919
Provider Name (Legal Business Name): LARONNA S. COLBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR. DR.
ATLANTA GA
30303
US

IV. Provider business mailing address

75 PIEDMONT AVE. 700
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4307
  • Fax: 770-939-2887
Mailing address:
  • Phone: 404-756-5271
  • Fax: 404-756-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number049231
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: