Provider Demographics
NPI:1942759527
Name:COLBERT, JOSEPH JR (MEDICAL SUPPLIER)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:COLBERT
Suffix:JR
Gender:M
Credentials:MEDICAL SUPPLIER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 KALEB CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7472
Mailing Address - Country:US
Mailing Address - Phone:678-708-3203
Mailing Address - Fax:
Practice Address - Street 1:305 KALEB CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7472
Practice Address - Country:US
Practice Address - Phone:678-708-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor