Healthcare Provider Details

I. General information

NPI: 1861323552
Provider Name (Legal Business Name): COLLIER OUTREACH MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 EXPERIMENT ST
GRIFFIN GA
30223-1735
US

IV. Provider business mailing address

151 LIBERTY CT
BYRON GA
31008-5652
US

V. Phone/Fax

Practice location:
  • Phone: 704-259-3276
  • Fax:
Mailing address:
  • Phone: 704-259-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: PHYLLIS COLLIER
Title or Position: CEO
Credential:
Phone: 704-259-3276