Provider Demographics
NPI:1235131509
Name:MCCOLLUM, JOHN ELLIOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ELLIOTT
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STANCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3326
Mailing Address - Country:US
Mailing Address - Phone:828-687-7832
Mailing Address - Fax:
Practice Address - Street 1:417 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4543
Practice Address - Country:US
Practice Address - Phone:828-255-4567
Practice Address - Fax:828-255-1910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2332505Medicare ID - Type Unspecified