Healthcare Provider Details

I. General information

NPI: 1942683818
Provider Name (Legal Business Name): CAROLINE G COLDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 CLINIC AVE
CARROLLTON GA
30117
US

IV. Provider business mailing address

119 AMBULANCE DR STE 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 770-838-8640
  • Fax: 770-838-8650
Mailing address:
  • Phone: 770-838-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7476
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number080656
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number080656
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: