Individual
MR. COLBY LAKE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
309 VERNON ST, LAGRANGE, GA 30240-3162
(706) 885-9110
Mailing address
110 LAKEMONT CT, LAGRANGE, GA 30240-7791
(706) 289-5132
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN259729
GA
Other
Enumeration date
02/09/2021
Last updated
02/09/2021
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