Provider Demographics
NPI:1043418692
Name:MCCOLLUM, CHARLES RAMSEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RAMSEY
Last Name:MCCOLLUM
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-5650
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-268-5650
Practice Address - Fax:601-579-5212
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2020-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS20908207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS6092134OtherHEALTHSPRINGS
MS6010038OtherCIGNA
MS08758585Medicaid
MS4225057OtherAETNA
MS3554163OtherUNITED HEALTHCARE
MS266808YKFFMedicare PIN