Provider Demographics
NPI:1336651728
Name:COLLIER, GREGORY A (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:COLLIER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5069
Mailing Address - Country:US
Mailing Address - Phone:828-264-4553
Mailing Address - Fax:828-262-3649
Practice Address - Street 1:169 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5069
Practice Address - Country:US
Practice Address - Phone:828-264-4553
Practice Address - Fax:828-262-3649
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-09521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant