MEDICARE: MR. COLIN T RIORDAN HCP, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	HADS000775	GA
2	237700000X	Hearing Instrument Specialist	HAS0475	SC

General Provider Information

NPI Number	:	1316182587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLIN T RIORDAN HCP, MBA

Provider Business Mailing Address
First Line	:	942 WOODY HILL CIR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-6714
Country	:	US
Telephone Number	:	706-840-1619
Fax Number	:	706-364-3187

Provider Business Practice Location Address
First Line	:	4210 COLUMBIA RD
Second Line	:	SUITE 5B
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0401
Country	:	US
Telephone Number	:	706-364-3184
Fax Number	:	706-364-3187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	06/14/2023

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