Provider Demographics
NPI:1578809646
Name:COLLEY, MEL O (NBC-HIS)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:O
Last Name:COLLEY
Suffix:
Gender:F
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 GRAND ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1299
Mailing Address - Country:US
Mailing Address - Phone:229-434-0213
Mailing Address - Fax:229-434-7476
Practice Address - Street 1:1310 BAYTREE RD STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3265
Practice Address - Country:US
Practice Address - Phone:229-259-9200
Practice Address - Fax:229-259-9003
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA456237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist