Organization
COLLABORATIVE GERIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY BROOKE TAYLOR (ADMINISTRATIVE ASSISTANT)
(304) 743-8007
Entity
Organization
Contact information
Practice address
414 MAHOGANYWOOD DR, MILTON, WV 25541-1181
(304) 743-8007
(304) 743-1704
Mailing address
PO BOX 979, CULLODEN, WV 25510-0979
(304) 743-8007
(304) 743-1704
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
14713
WV
207QG0300X
Geriatric Medicine (Family Medicine) Physician
1601
WV
207QG0300X
Geriatric Medicine (Family Medicine) Physician
20005
WV
207QG0300X
Geriatric Medicine (Family Medicine) Physician
21327
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0040807000
—
WV
Enumeration date
06/24/2006
Last updated
08/22/2020
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