Provider Demographics
NPI:1639417355
Name:PIERRE, MAXWELL COLLIMORE I
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:COLLIMORE
Last Name:PIERRE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 WINDERMERE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6121
Mailing Address - Country:US
Mailing Address - Phone:678-508-2523
Mailing Address - Fax:770-808-4391
Practice Address - Street 1:2680 HIGHWAY 81 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7514
Practice Address - Country:US
Practice Address - Phone:678-508-2523
Practice Address - Fax:770-808-4391
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188675163WC0400X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No163WC0400XNursing Service ProvidersRegistered NurseCase Management