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General NPI Number Information
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NPI Number | 1770709628
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Entity Type | Individual
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Provider Name | CHARLES TRUMAN COLBERT JR. C.S.T./C.F.A.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 6525 PROFESSIONAL PL SUITE A
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City | RIVERDALE
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State | GA
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Zip | 30274-2519
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Country | US
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Telephone | 770-991-1150
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Fax | 770-991-1155
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Provider Business Mailing Address
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Address Line | 334 DYLAN WAY
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City | MCDONOUGH
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State | GA
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Zip | 30252-6186
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Country | US
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Telephone | 770-914-1517
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Fax | 770-991-1155
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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