Provider Demographics
NPI:1396928222
Name:COLLIER, CHARLENE HOOPER (MD, MPH, MHS)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:HOOPER
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MD, MPH, MHS
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:HOOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:633 KINSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4138
Mailing Address - Country:US
Mailing Address - Phone:401-743-7665
Mailing Address - Fax:601-984-5317
Practice Address - Street 1:633 KINSINGTON CT
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4138
Practice Address - Country:US
Practice Address - Phone:401-743-7665
Practice Address - Fax:601-984-5317
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049793207V00000X
PAMD479763207V00000X
MS22675207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06874545Medicaid
MS297767YJ5DMedicare PIN