Individual
ETHAN COLLIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 GILMORE DR, AMORY, MS 38821-5414
(662) 256-3564
Mailing address
808 VARSITY DR, TUPELO, MS 38801-4613
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29558
MS
Other
Enumeration date
06/03/2020
Last updated
10/18/2023
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