Individual
MICHAEL COULTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 10TH AVE STE 100, COLUMBUS, GA 31901-3601
(706) 571-1430
(706) 571-1604
Mailing address
1800 10TH AVE, COLUMBUS, GA 31901-1513
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
005235
GA
Other
Enumeration date
06/28/2011
Last updated
07/01/2011
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