Provider Demographics
NPI:1306937461
Name:COLLINS, DOUGLAS CALDWELL (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CALDWELL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PARKWAY DR NE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1213
Mailing Address - Country:US
Mailing Address - Phone:404-522-0917
Mailing Address - Fax:404-522-0953
Practice Address - Street 1:320 PARKWAY DR NE
Practice Address - Street 2:SUITE 232
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1213
Practice Address - Country:US
Practice Address - Phone:404-522-0917
Practice Address - Fax:404-522-0953
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020092207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000230095FMedicaid
GA00230095CMedicaid
GA83BBBQRMedicare PIN
GA000230095FMedicaid