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General NPI Number Information
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NPI Number | 1306527478
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Entity Type | Individual
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Provider Name | NICHOLAS B COLVIN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1091 BARBER CREEK RD
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City | STATHAM
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State | GA
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Zip | 30666-3153
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Country | US
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Telephone | 678-325-8912
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Fax |
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Provider Business Mailing Address
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Address Line | 1091 BARBER CREEK RD
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City | STATHAM
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State | GA
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Zip | 30666-3153
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Country | US
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Telephone | 770-855-4434
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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 | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 13201
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License Number State | NC
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