Provider Demographics
NPI:1659325322
Name:MCCOLLUM, LIONEL D (MD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:D
Last Name:MCCOLLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 PARKWEST BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-769-4444
Mailing Address - Fax:865-769-4419
Practice Address - Street 1:9430 PARKWEST BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-769-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12163207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3894349Medicaid
TNB04826Medicare UPIN
TN3894349Medicaid