Individual
MICHELLE MCCOLLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
401 6TH AVE, SUITE 102, MONTGOMERY, WV 25136-2116
(304) 442-8381
Mailing address
PO BOX 30, MONTGOMERY, WV 25136-0030
(304) 442-8381
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01025
WV
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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