Michael J Collier, DDS
Individual provider Active NPI Dentist · Oakwood, GA
NPI 1306986799 · NPPES record last updated Dec 30, 2016
Key facts
- NPI
- 1306986799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN007538 (GA)
- Practice address
- 4211 Mundy Mill PL
Suite a
Oakwood, GA 30566-2530 - Phone
- (770) 535-8160
- Fax
- (770) 287-0941
- NPI assigned
- Feb 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170117001380 | GA | Order and Referring Only - Dentist |
4385926948 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN007538 | GA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN007538 | GA | Yes |
Addresses
Primary practice location
4211 Mundy Mill PL
Suite a
Oakwood, GA 30566-2530
Mailing address
PO Box 969
Oakwood, GA 30566-0017
Phone (770) 535-8160
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119070329A | Medicaid | GA |
Other providers in Oakwood, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.