Basic Information
| Provider Information | |||||||||
| NPI: | 1679665640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLEY | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | JUDSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3686 GRANDVIEW PKWY STE 720 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352433408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059717538 | ||||||||
| FaxNumber: | 2059717572 | ||||||||
| Practice Location | |||||||||
| Address1: | 3686 GRANDVIEW PKWY STE 720 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352433408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059717500 | ||||||||
| FaxNumber: | 2059717572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 23975 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 20613 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | ME 98666 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 20613 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | ME 98666 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 24202 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 09872218 | 05 | MS | MEDICAID | H6647300281 | 01 | SOLE PROPRIETOR ID | OTHER |