Healthcare Provider Details

I. General information

NPI: 1275447203
Provider Name (Legal Business Name): COLTON SHAFER RIPPEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

3939 ROSWELL RD STE 200
MARIETTA GA
30062-6285
US

IV. Provider business mailing address

1950 ROSWELL RD APT 16A2
MARIETTA GA
30068-3003
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-3940
  • Fax:
Mailing address:
  • Phone: 623-695-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: