Provider Demographics
NPI:1629247929
Name:JOSEPH F COLLIGAN MD
Entity Type:Organization
Organization Name:JOSEPH F COLLIGAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-455-5551
Mailing Address - Street 1:825 GUMBRANCH ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540
Mailing Address - Country:US
Mailing Address - Phone:910-455-5551
Mailing Address - Fax:910-938-2556
Practice Address - Street 1:825 GUMBRANCH ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-455-5551
Practice Address - Fax:910-938-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15997352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8923782Medicaid
NC23782OtherBC
NC8923782Medicaid
NC23782OtherBC