Healthcare Provider Details

I. General information

NPI: 1659427607
Provider Name (Legal Business Name): COLLEEN DASCHBACH WOLFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN AGNES WOLFORD FNP

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 SAINT SEBASTIAN WAY
AUGUSTA GA
30912-5741
US

IV. Provider business mailing address

426 GEMSTONE CT
EVANS GA
30809-6055
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3448
  • Fax:
Mailing address:
  • Phone: 706-787-9122
  • Fax: 706-787-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN229848
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: