Provider Demographics
NPI:1780679365
Name:COLLIER, LEE F (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:F
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:277 INDUSTRIAL BLVD
Mailing Address - Street 2:P O BOX 353
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040
Mailing Address - Country:US
Mailing Address - Phone:478-272-1366
Mailing Address - Fax:478-275-2322
Practice Address - Street 1:104 FAIRVIEW PARK DRIVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1366
Practice Address - Fax:478-277-1922
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA048033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000910115HMedicaid
GAH33570Medicare UPIN
GA202I110917Medicare PIN
GA000910115EMedicaid