Healthcare Provider Details

I. General information

NPI: 1386841617
Provider Name (Legal Business Name): GREGORY PAUL COLBATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 N LIMESTONE ST STE B
GAFFNEY SC
29340-4750
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-488-3336
  • Fax: 864-488-4439
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number29863
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: