Provider Demographics
NPI:1437454782
Name:COLLIER, NICHOLES ANTONIO
Entity Type:Individual
Prefix:
First Name:NICHOLES
Middle Name:ANTONIO
Last Name:COLLIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CHEATHAM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2828
Mailing Address - Country:US
Mailing Address - Phone:615-463-6200
Mailing Address - Fax:
Practice Address - Street 1:713 CHEATHAM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2828
Practice Address - Country:US
Practice Address - Phone:615-463-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN089550459171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator