Individual
DEREK COLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1341 W HILL AVE, VALDOSTA, GA 31601-5235
(229) 221-8292
Mailing address
1551 DILLON RD, THOMASVILLE, GA 31757-2242
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
044327071
GA
Other
Enumeration date
10/14/2016
Last updated
10/14/2016
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