Healthcare Provider Details

I. General information

NPI: 1508778150
Provider Name (Legal Business Name): COLLEEN M FERNANDEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4800
  • Fax: 706-432-4798
Mailing address:
  • Phone: 706-432-4800
  • Fax: 706-432-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212129
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: