Provider Demographics
NPI:1154588036
Name:COLEY COSMETIC & HAND SURGERY CENTER, PA
Entity type:Organization
Organization Name:COLEY COSMETIC & HAND SURGERY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRILL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-617-8645
Mailing Address - Street 1:3625 N ELM ST STE 120
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2696
Mailing Address - Country:US
Mailing Address - Phone:336-617-8645
Mailing Address - Fax:336-617-8646
Practice Address - Street 1:3625 N ELM ST STE 120
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2696
Practice Address - Country:US
Practice Address - Phone:336-288-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00266261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty