Provider Demographics
NPI:1457963712
Name:LAGARMON, COLBY JANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COLBY
Middle Name:JANE
Last Name:LAGARMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COLBY
Other - Middle Name:JANE
Other - Last Name:LAFEVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 WAYFAIR OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3546
Mailing Address - Country:US
Mailing Address - Phone:770-362-9180
Mailing Address - Fax:
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8018
Practice Address - Country:US
Practice Address - Phone:470-639-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant