Provider Demographics
NPI:1649445883
Name:STEELE, COLLYN ANZEL (MD)
Entity type:Individual
Prefix:
First Name:COLLYN
Middle Name:ANZEL
Last Name:STEELE
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 1:50 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6097
Mailing Address - Country:US
Mailing Address - Phone:770-957-1887
Mailing Address - Fax:770-957-6864
Practice Address - Street 1:50 KELLY RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6097
Practice Address - Country:US
Practice Address - Phone:770-957-1887
Practice Address - Fax:770-957-6864
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112952AMedicaid
GA202I085253Medicare PIN