Individual
HERBERT ROSWELL COLCORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3015 LEXINGTON RD, ATHENS, GA 30605-2491
(706) 613-3270
Mailing address
4621 BENTLEY PL, PEACHTREE CORNERS, GA 30096-6128
(404) 731-3866
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
RN167054
GA
Other
Enumeration date
09/05/2018
Last updated
09/05/2018
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