MEDICARE: LAUREN EMILY MCCOLLUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	61172	TN
2	2084N0400X	Neurology Physician	MT206562	PA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1255759288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN EMILY MCCOLLUM MD

Provider Business Mailing Address
First Line	:	1932 ALCOA HWY STE 150
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1532
Country	:	US
Telephone Number	:	865-305-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1932 ALCOA HWY STE 150
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1532
Country	:	US
Telephone Number	:	865-305-7311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	07/30/2020

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