Provider Demographics
NPI:1124311212
Name:SEGOVIS, COLIN MICHAEL (MD, PHD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:MICHAEL
Last Name:SEGOVIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30332-0001
Mailing Address - Country:US
Mailing Address - Phone:404-712-5287
Mailing Address - Fax:404-712-7839
Practice Address - Street 1:EMORY UNIVERSITY 1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332
Practice Address - Country:US
Practice Address - Phone:404-778-4889
Practice Address - Fax:404-778-0826
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-020422085R0202X
GA795542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology