Provider Demographics
NPI:1942299359
Name:MCCOLLUM, JOSHUA MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
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 1:1253 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8365
Mailing Address - Country:US
Mailing Address - Phone:615-790-7992
Mailing Address - Fax:615-790-8688
Practice Address - Street 1:1253 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-8365
Practice Address - Country:US
Practice Address - Phone:615-790-7992
Practice Address - Fax:615-790-8688
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31962207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10922Medicare UPIN
3850076Medicare ID - Type Unspecified