Provider Demographics
NPI:1467658666
Name:MCCOLL, KAREN JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JOAN
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-537-4986
Mailing Address - Fax:912-538-8166
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8845
Practice Address - Country:US
Practice Address - Phone:912-537-1014
Practice Address - Fax:912-538-1538
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2019-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA053282207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA734884631AMedicaid
GA734884631AMedicaid