Provider Demographics
NPI:1386841617
Name:COLBATH, GREGORY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:COLBATH
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1552 N LIMESTONE ST STE B
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4750
Practice Address - Country:US
Practice Address - Phone:864-488-3336
Practice Address - Fax:864-488-4439
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29863207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC16696067OtherMEDICARE PIN
SC298635Medicaid
SCSC16697951Medicare PIN