Healthcare Provider Details

I. General information

NPI: 1689205593
Provider Name (Legal Business Name): TIARA LEONNA COLBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AVENUE F
THOMASTON GA
30286-3829
US

IV. Provider business mailing address

200 BARNETT LN
THOMASTON GA
30286-5460
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-6676
  • Fax: 706-647-0374
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN239116
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN239116
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: