Provider Information for 1083002620
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MICHAL ANGELIQUE COLLIER
Sex: Female
NPI: 1083002620
Last Updated: 2015-01-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1083002620 | ||||||||||||
| Enumeration Date | 2015-01-06 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 371218 DECATUR, GA 30037-1218 United States Phone: 404-593-9921 | Fax:404-596-8583 | ||||||||||||
| Primary Practice Address | 4246 MOUNTAIN GLEN TRCE SNELLVILLE, GA 30039-6475 United States Phone: 404-593-9921 | Fax:404-596-8583 | ||||||||||||
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