Provider Demographics
NPI:1306860044
Name:COLLIER, MILLARD JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:MILLARD
Middle Name:JAMES
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:939 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2634
Mailing Address - Country:US
Mailing Address - Phone:770-948-5400
Mailing Address - Fax:770-948-4930
Practice Address - Street 1:939 THORNTON RD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2634
Practice Address - Country:US
Practice Address - Phone:770-948-5400
Practice Address - Fax:770-948-4930
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00312936DMedicaid
GAD61141Medicare UPIN
GA08BBWFTMedicare ID - Type UnspecifiedMEDICARE NUMBER