Provider Demographics
NPI:1356585301
Name:COLLIER, KEVA WONTORIA (MD)
Entity type:Individual
Prefix:
First Name:KEVA
Middle Name:WONTORIA
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 SOLLIE RD
Mailing Address - Street 2:1321
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-5532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2889 SOLLIE RD
Practice Address - Street 2:1321
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-5532
Practice Address - Country:US
Practice Address - Phone:919-423-7883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.3786R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine