Healthcare Provider Details

I. General information

NPI: 1306918982
Provider Name (Legal Business Name): COL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 5TH ST N
COLUMBUS MS
39705-2019
US

IV. Provider business mailing address

2526 5TH ST N
COLUMBUS MS
39705-2019
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-8402
  • Fax: 662-328-1554
Mailing address:
  • Phone: 662-328-8402
  • Fax: 662-328-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W. HOLMES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 337-291-9161