Basic Information
| Provider Information | |||||||||
| NPI: | 1982672648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOLLUM | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 ACCELERATOR WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379203078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462663 | ||||||||
| FaxNumber: | 8655469047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 ACCELERATOR WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379203078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655462663 | ||||||||
| FaxNumber: | 8655469047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD30059 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200041201 | 01 | TN | RAILROAD MEDICARE | OTHER | 3822714 | 05 | TN | MEDICAID | 5249620 | 01 | TN | AETNA | OTHER | TN01B3 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 6412358100 | 05 | KY | MEDICAID | 4009437 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | TN01A5 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER |