Basic Information
Provider Information
NPI: 1215958020
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLLINS
FirstName: JAMES
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 E 2ND AVE
Address2: SUITE 103
City: ROME
State: GA
PostalCode: 301613224
CountryCode: US
TelephoneNumber: 7065093000
FaxNumber: 7062927600
Practice Location
Address1: 330 TURNER MCCALL BLVD SW
Address2: SUITE 101
City: ROME
State: GA
PostalCode: 301655630
CountryCode: US
TelephoneNumber: 7062912745
FaxNumber: 7062916759
Other Information
ProviderEnumerationDate: 07/21/2006
LastUpdateDate: 06/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X029833GAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home