Provider Demographics
NPI:1336223684
Name:COLLIER, MARILYN SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:SUE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY HALL
Mailing Address - State:GA
Mailing Address - Zip Code:31831-2605
Mailing Address - Country:US
Mailing Address - Phone:706-582-3585
Mailing Address - Fax:
Practice Address - Street 1:MACH RPC
Practice Address - Street 2:MARTIN LOOP BLDG 9224
Practice Address - City:FT. BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-1419
Practice Address - Fax:706-544-2790
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN063533164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse