Healthcare Provider Details

I. General information

NPI: 1518871458
Provider Name (Legal Business Name): COLBY GRACE SPETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4434 COLUMBIA RD
AUGUSTA GA
30907-4556
US

IV. Provider business mailing address

335 STAGECOACH WAY
AUGUSTA GA
30907-3329
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-4007
  • Fax:
Mailing address:
  • Phone: 706-910-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2813401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: