Provider Demographics
NPI:1134473739
Name:COLLIER, MICHAEL RODGERS (DPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RODGERS
Last Name:COLLIER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5205
Mailing Address - Country:US
Mailing Address - Phone:423-877-5226
Mailing Address - Fax:
Practice Address - Street 1:526 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3849
Practice Address - Country:US
Practice Address - Phone:706-861-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025308183500000X
TN5584183500000X
FLPS36445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist