Provider Demographics
NPI:1356105506
Name:WISDOM, COLBY (PA-C)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:WISDOM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5164
Mailing Address - Country:US
Mailing Address - Phone:931-201-0528
Mailing Address - Fax:
Practice Address - Street 1:2070 WALL ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-4208
Practice Address - Country:US
Practice Address - Phone:615-567-8965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant