Provider Demographics
NPI:1699550368
Name:KOLATH, DYLAN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:KOLATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 WARM SPRINGS RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7310
Mailing Address - Country:US
Mailing Address - Phone:706-410-2740
Mailing Address - Fax:706-410-2740
Practice Address - Street 1:4745 WARM SPRINGS RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7310
Practice Address - Country:US
Practice Address - Phone:706-410-2740
Practice Address - Fax:706-410-2740
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide