Basic Information
| Provider Information | |||||||||
| NPI: | 1780979211 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLBURN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1949 GUNBARREL RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234954345 | ||||||||
| FaxNumber: | 4234954934 | ||||||||
| Practice Location | |||||||||
| Address1: | 3739 HIXSON PIKE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374153520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238750999 | ||||||||
| FaxNumber: | 4238750896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2011 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 071481 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 50198 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 50198 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.