Provider Demographics
NPI:1417407305
Name:COLBERT SALES LLC
Entity type:Organization
Organization Name:COLBERT SALES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-708-3203
Mailing Address - Street 1:305 KALEB CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7472
Mailing Address - Country:US
Mailing Address - Phone:678-708-3203
Mailing Address - Fax:
Practice Address - Street 1:305 KALEB CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7472
Practice Address - Country:US
Practice Address - Phone:678-708-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42747332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies