Provider Demographics
NPI:1275009433
Name:COLLINGSWORTH, TEDDY W (FNP)
Entity type:Individual
Prefix:
First Name:TEDDY
Middle Name:W
Last Name:COLLINGSWORTH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3696 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6520
Mailing Address - Country:US
Mailing Address - Phone:706-736-1830
Mailing Address - Fax:
Practice Address - Street 1:1220 GEORGE C WILSON DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4501
Practice Address - Country:US
Practice Address - Phone:762-716-1012
Practice Address - Fax:762-716-1013
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN227420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily