Provider Demographics
NPI:1053801498
Name:COLASURDO, JOSEPH NICHOLAS (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:COLASURDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6350 LAKE OCONEE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-6490
Mailing Address - Country:US
Mailing Address - Phone:706-597-0102
Mailing Address - Fax:
Practice Address - Street 1:202 INSPERON DR STE 202
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-0602
Practice Address - Country:US
Practice Address - Phone:706-597-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007215213ES0103X
GAPOD001547213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery