Provider Demographics
NPI:1609014349
Name:COLD, GEORGIA K (NATL BOARD CHT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:K
Last Name:COLD
Suffix:
Gender:F
Credentials:NATL BOARD CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W MENDENHALL ST STE A2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3213
Mailing Address - Country:US
Mailing Address - Phone:406-586-5515
Mailing Address - Fax:
Practice Address - Street 1:1015 W MENDENHALL ST STE A2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3213
Practice Address - Country:US
Practice Address - Phone:406-586-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTF-GC2013020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist