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General NPI Number Information
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NPI Number | 1497851398
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Entity Type | Individual
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Provider Name | GABRIEL COLON O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 270 WALMART WAY
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City | DAHLONEGA
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State | GA
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Zip | 30533-0816
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Country | US
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Telephone | 706-867-9335
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Fax | 706-867-8679
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Provider Business Mailing Address
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Address Line | 3415 CROOKED STICK DR
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City | CUMMING
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State | GA
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Zip | 30041-5794
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Country | US
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Telephone | 770-596-3197
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Fax | 706-867-8679
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002226
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License Number State | GA
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