Provider Demographics
NPI:1487731121
Name:COLGROVE, ROBERT ALTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALTON
Last Name:COLGROVE
Suffix:JR
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 THE EXCHANGE SE
Mailing Address - Street 2:BLDG 300, STE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-955-9000
Mailing Address - Fax:
Practice Address - Street 1:4300 PACES FERRY RD SE
Practice Address - Street 2:SUITE 478
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5703
Practice Address - Country:US
Practice Address - Phone:770-432-2191
Practice Address - Fax:770-432-1737
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028750208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00339127AMedicaid
GAD39624Medicare UPIN