Provider Demographics
NPI:1164405189
Name:MCILWAIN-MCCOLLUM, ANJANETTE LAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJANETTE
Middle Name:LAURICE
Last Name:MCILWAIN-MCCOLLUM
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:6387 RAMSEY ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9441
Mailing Address - Country:US
Mailing Address - Phone:910-615-3960
Mailing Address - Fax:910-486-2159
Practice Address - Street 1:6387 RAMSEY ST
Practice Address - Street 2:SUITE 240
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9441
Practice Address - Country:US
Practice Address - Phone:910-615-3960
Practice Address - Fax:910-486-2159
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2024-01-24
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Provider Licenses
StateLicense IDTaxonomies
NC200200411208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H07339Medicare UPIN