Provider Demographics
NPI:1669467262
Name:COLLIER, JOHN REGINALD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REGINALD
Last Name:COLLIER
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 1:2520 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0635
Mailing Address - Country:US
Mailing Address - Phone:704-868-8400
Mailing Address - Fax:704-868-8493
Practice Address - Street 1:2520 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0635
Practice Address - Country:US
Practice Address - Phone:704-868-8400
Practice Address - Fax:704-868-8493
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2019464OtherAETNA HEALTHCARE
SCN21759OtherSOUTH CAROLINA MEDICAID
NC1549303004OtherCIGNA HEALTHCARE
NC23777OtherBLUE CROSS BLUE SHIELD
NC53853OtherMEDCOST
NC8923777Medicaid
NC10-41172OtherUNITED HEALTHCARE
NC168236OtherMIDSOUTH INS
NC2103803OtherMAMSI
NC343001OtherCOVENTRY HEALTHCARE
NC10309OtherPARTNERS HEALTHPLAN
NC2019464OtherAETNA HEALTHCARE
NC8923777Medicaid