Healthcare Provider Details

I. General information

NPI: 1477209062
Provider Name (Legal Business Name): DAVID MCCOLLAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MIDWAY LOOP
ELKINS WV
26241-1373
US

IV. Provider business mailing address

27 MIDWAY LOOP
ELKINS WV
26241-1373
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-5252
  • Fax:
Mailing address:
  • Phone: 304-636-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: