Provider Demographics
NPI:1194937458
Name:COLLINS, JAMES RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EAGLES POINTE PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6379
Mailing Address - Country:US
Mailing Address - Phone:770-474-7177
Mailing Address - Fax:770-474-9111
Practice Address - Street 1:125 EAGLES POINTE PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6379
Practice Address - Country:US
Practice Address - Phone:770-474-7177
Practice Address - Fax:770-474-9111
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics