MEDICARE: DR. ROBERT ALTON COLGROVE JR. M.D.

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	208200000X	Plastic Surgery Physician	028750	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487731121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALTON COLGROVE JR. M.D.

Provider Business Mailing Address
First Line	:	1900 THE EXCHANGE SE
Second Line	:	BLDG 300, STE 300
City	:	ATLANTA
State	:	GA
Zip	:	30339
Country	:	US
Telephone Number	:	770-955-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 PACES FERRY RD SE
Second Line	:	SUITE 478
City	:	ATLANTA
State	:	GA
Zip	:	30339-5703
Country	:	US
Telephone Number	:	770-432-2191
Fax Number	:	770-432-1737

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/02/2017

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