Provider Demographics
NPI:1306836747
Name:COLON, ENID (MD)
Entity Type:Individual
Prefix:DR
First Name:ENID
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 HAYNES BRIDGE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1968
Mailing Address - Country:US
Mailing Address - Phone:770-345-0055
Mailing Address - Fax:770-345-0020
Practice Address - Street 1:205 WALESKA RD STE 1C
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2493
Practice Address - Country:US
Practice Address - Phone:770-345-0055
Practice Address - Fax:770-345-0020
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43020OtherMEDICAL LICENSE
GABC5331169OtherDEA