Basic Information
| Provider Information | |||||||||
| NPI: | 1083624365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | SIDNEY | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL PARK BLVD, 250 WEST | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446620 | ||||||||
| FaxNumber: | 4238446626 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK BLVD, 250 WEST | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238446620 | ||||||||
| FaxNumber: | 4238446626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | E5311 | AR | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 40441 | 01 | TN | MEDICAL LICENSE | OTHER |