Individual
MR. KENNON HOWARD MCCOLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN
Contact information
Practice address
1045 SOUTHCREST DR, SUITE 200, STOCKBRIDGE, GA 30281-6113
(678) 289-0549
(678) 289-8756
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(678) 289-0549
(678) 289-8756
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN102128
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000968745H
—
GA
05
—
000968745J
—
GA
05
—
000968745K
—
GA
Enumeration date
01/09/2006
Last updated
08/19/2020
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