Provider Demographics
NPI:1891900700
Name:COLLIER, JUSTIN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:THOMAS
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 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:615-868-4600
Mailing Address - Fax:615-868-4001
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 520
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-868-4600
Practice Address - Fax:615-868-4001
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118576208100000X
TN43962208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514057Medicaid
KY7100092830Medicaid
KY7100092830Medicaid