Healthcare Provider Details

I. General information

NPI: 1710682091
Provider Name (Legal Business Name): MICHELE COLLINGSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 T.T. LANIER STREET
LILLINGTON NC
27546
US

IV. Provider business mailing address

129 T.T. LANIER STREET
LILLINGTON NC
27546
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-7515
  • Fax:
Mailing address:
  • Phone: 910-893-7515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5151016322
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: