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General NPI Number Information
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NPI Number | 1467151746
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Entity Type | Individual
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Provider Name | DR. RANDA COLBERT
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 204 E COLLEGE ST
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City | ATHENS
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State | TN
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Zip | 37303-3604
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Country | US
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Telephone | 423-584-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 379 QUAIL RUN TRCE NE
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City | CLEVELAND
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State | TN
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Zip | 37312-6686
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Country | US
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Telephone | 423-584-1070
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH6630
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License Number State | TN
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