Provider Demographics
NPI:1114029279
Name:MCLEMORE, COLLEEN O (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:O
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5485
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-5485
Mailing Address - Country:US
Mailing Address - Phone:706-353-3794
Mailing Address - Fax:706-353-3772
Practice Address - Street 1:215A HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-353-3794
Practice Address - Fax:706-353-3772
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0283562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
050832Medicare UPIN
26BDBVBMedicare ID - Type Unspecified