MEDICARE: KENT ALLEN COLBURN DO

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	2084P0800X	Psychiatry Physician	34005379	OH
2	2084P0800X	Psychiatry Physician	2157	TN

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	:	1588739890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT ALLEN COLBURN DO

Provider Business Mailing Address
First Line	:	1670 UPHAM DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1250
Country	:	US
Telephone Number	:	614-293-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 22ND AVE N
Second Line	:	SUITE 100
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1870
Country	:	US
Telephone Number	:	615-916-3825
Fax Number	:	615-916-3826

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	11/21/2019

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