MEDICARE: COLBY CARLSON

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	207P00000X	Emergency Medicine Physician	6260	SC
2	363A00000X	Physician Assistant	6260	SC

General Provider Information

NPI Number	:	1548043482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLBY CARLSON

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-695-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 GROVE RD FL 1
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4210
Country	:	US
Telephone Number	:	864-455-7899
Fax Number	:	864-455-5474

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	03/02/2026

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Directions to “ COLBY CARLSON ” Practice Location

Language	Start Address	Practice Location

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