Healthcare Provider Details

I. General information

NPI: 1083702427
Provider Name (Legal Business Name): MANUEL ANGEL COLON-DEJESUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANUEL ANGEL COLON-DEJESUS M.D.

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 MERIDIAN DRIVE
SNEADS FERRY NC
28460
US

IV. Provider business mailing address

1057 MERIDIAN DRIVE
SNEADS FERRY NC
28460
US

V. Phone/Fax

Practice location:
  • Phone: 678-328-9539
  • Fax:
Mailing address:
  • Phone: 678-328-9539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number9812
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number46838
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: