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General NPI Number Information
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NPI Number | 1043173164
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Entity Type | Individual
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Provider Name | COLTON ELMORE 390200000X
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Gender | Male
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 20767 AL HIGHWAY 55
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City | ANDALUSIA
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State | AL
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Zip | 36420-6626
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Country | US
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Telephone | 334-343-1053
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Fax |
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Provider Business Mailing Address
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Address Line | 20767 AL HIGHWAY 55
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City | ANDALUSIA
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State | AL
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Zip | 36420-6626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AL
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