1255665980 NPI number — MR. PURVIS COLLIER P.A.

Table of content: MR. PURVIS COLLIER P.A. (NPI 1255665980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255665980 NPI number — MR. PURVIS COLLIER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLIER
Provider First Name:
PURVIS
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255665980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 N WESTOVER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31707-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-888-6559
Provider Business Mailing Address Fax Number:
229-436-4107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1712 E BROAD AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31705-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-639-3100
Provider Business Practice Location Address Fax Number:
229-888-6516
Provider Enumeration Date:
09/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  1445 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 006976 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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