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General NPI Number Information
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NPI Number | 1639417355
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Entity Type | Individual
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Provider Name | MR. MAXWELL COLLIMORE PIERRE I
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Gender | Male
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 2680 HIGHWAY 81 S
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City | COVINGTON
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State | GA
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Zip | 30016-7514
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Country | US
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Telephone | 678-508-2523
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Fax | 770-808-4391
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Provider Business Mailing Address
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Address Line | 5824 WINDERMERE CT
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City | LITHONIA
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State | GA
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Zip | 30038-6121
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Country | US
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Telephone | 678-508-2523
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Fax | 770-808-4391
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | RN188675
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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