Provider Demographics
NPI:1255665980
Name:COLLIER, PURVIS (PA)
Entity Type:Individual
Prefix:MR
First Name:PURVIS
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:1712 E BROAD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-2611
Practice Address - Country:US
Practice Address - Phone:229-639-3100
Practice Address - Fax:229-888-6516
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1445363A00000X
GA006976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant