Provider Demographics
NPI:1770709628
Name:COLBERT, CHARLES TRUMAN JR (CST/CFA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:TRUMAN
Last Name:COLBERT
Suffix:JR
Gender:M
Credentials:CST/CFA
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Mailing Address - Street 1:334 DYLAN WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6186
Mailing Address - Country:US
Mailing Address - Phone:770-914-1517
Mailing Address - Fax:770-991-1155
Practice Address - Street 1:6525 PROFESSIONAL PL
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2519
Practice Address - Country:US
Practice Address - Phone:770-991-1150
Practice Address - Fax:770-991-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-03-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist