Colby Lake Nicholson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN259729 Issued in GA

Practice address

309 Vernon St
Lagrange, GA 30240-3162

Phone

(706) 885-9110

NPI assigned

Feb 9, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgencare, LLCGroup PAC ID 7113250325, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: cnicholson157351@directwellstar.org
• FHIR API: https://api.platform.athenahealth.com/13107/brand/1/csg/1/fhir/r4
• Direct secure messaging: colby.nicholson.1@13107.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Urgencare, LLC

  • Urgent Care Clinic/Center
  • Lagrange, GA
  • NPI 1598223844
  Medicare reassignment Care Compare group
• Lagrange Med Center, LLC

  • Family Medicine Physician
  • Lagrange, GA
  • NPI 1043318355
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1558953737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LAKEMONT CT",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302407791",
            "telephone_number": "706-289-5132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 VERNON ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302403162",
            "telephone_number": "706-885-9110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "COLBY",
        "middle_name": "LAKE",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-02-09",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN259729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristopher Nelson, DO
• Nephrology Consultants of West Georgia
• Neurology Center of West Georgia PC
• Robin Newman, RN
• Quoc Vinh Ngo, M.D
• Nra-Lagrange, Georgia, LLC (Lagrange Dialysis Clinic)
• Swaroop Nyshadham, M.D.
• Anna Odom, NP
• Leslie Jean Ogilvy, PA-C
• Anna R Ogletree, RN

• Family Nurse Practitioner in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.