Provider Demographics
NPI:1841940582
Name:COLLIER, JACOB JAMES (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JAMES
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SHORTER AVE NW STE 201
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4256
Mailing Address - Country:US
Mailing Address - Phone:706-509-3300
Mailing Address - Fax:
Practice Address - Street 1:304 SHORTER AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4256
Practice Address - Country:US
Practice Address - Phone:706-509-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA97163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program