Provider Demographics
NPI:1811959679
Name:MCCOLLUM, AMY E (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:RIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5295 PRESERVE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4701
Mailing Address - Country:US
Mailing Address - Phone:205-987-4444
Mailing Address - Fax:205-987-4451
Practice Address - Street 1:5295 PRESERVE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4701
Practice Address - Country:US
Practice Address - Phone:205-987-4444
Practice Address - Fax:205-987-4451
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30180208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-14676OtherBCBS
AL000127948Medicaid
AL1811959679OtherTRICARE SOUTH
AL000127948Medicaid