Provider Demographics
NPI:1083745335
Name:COLY, ERASME (MD)
Entity Type:Individual
Prefix:DR
First Name:ERASME
Middle Name:
Last Name:COLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N STATE OF FRANKLIN RD
Mailing Address - Street 2:STE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3645
Mailing Address - Country:US
Mailing Address - Phone:423-926-4468
Mailing Address - Fax:423-928-4838
Practice Address - Street 1:701 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE 9
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3645
Practice Address - Country:US
Practice Address - Phone:423-926-4468
Practice Address - Fax:423-928-4838
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049439207RC0000X
SC18820207RC0000X, 207RI0011X
TN54651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF365496891OtherMEDICARE
SC060062892OtherMEDICARE RAILROAD
SC18820OtherSTATE ID
SC188200Medicaid
SC571109147OtherTAX ID
GA11BDVMHOtherMEDICARE
SC188200Medicaid
SCF365496891OtherMEDICARE