Provider Demographics
NPI:1285780668
Name:COLLINS, DOUGLAS ANTHONY (PA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ANTHONY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178A HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3139
Mailing Address - Country:US
Mailing Address - Phone:706-745-4191
Mailing Address - Fax:706-745-9370
Practice Address - Street 1:178 A HOSPITAL ROAD
Practice Address - Street 2:STE A
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-745-4191
Practice Address - Fax:706-745-9370
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001361AMedicaid
GA335862OtherWELLCARE
S51130Medicare UPIN
GA100001361AMedicaid