Provider Demographics
NPI:1407001795
Name:MCCOLLUM, SANGEETHA VARGHESE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SANGEETHA
Middle Name:VARGHESE
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STONECREST BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5689
Mailing Address - Country:US
Mailing Address - Phone:615-223-9502
Mailing Address - Fax:615-223-9596
Practice Address - Street 1:300 STONECREST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5689
Practice Address - Country:US
Practice Address - Phone:615-223-9502
Practice Address - Fax:615-223-9596
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1600363AM0700X, 207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine