Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 20908 | MS |
NPI | 1043418692 |
---|---|
Provider Name | Dr. Charles Ramsey Mccollum III |
First Address | Hattiesburg, MS 39401-7246 |
Second Address | Hattiesburg, MS 39401-7246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08758585 | (05) | MS |
3554163 | UNITED HEALTHCARE (01) | MS |
4225057 | AETNA (01) | MS |
6010038 | CIGNA (01) | MS |
6092134 | HEALTHSPRINGS (01) | MS |