Provider Demographics
NPI:1154628196
Name:HINDS MCPHOY, COLLEEN ANDREA
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANDREA
Last Name:HINDS MCPHOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12264 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-5391
Mailing Address - Country:US
Mailing Address - Phone:678-478-8304
Mailing Address - Fax:
Practice Address - Street 1:11264 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-7012
Practice Address - Country:US
Practice Address - Phone:678-478-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028865711376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide