Provider Demographics
NPI:1528117728
Name:COLLINS CARDIOLOGY
Entity type:Organization
Organization Name:COLLINS CARDIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-384-6276
Mailing Address - Street 1:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2109
Mailing Address - Country:US
Mailing Address - Phone:912-384-6276
Mailing Address - Fax:912-389-1618
Practice Address - Street 1:1208 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2220
Practice Address - Country:US
Practice Address - Phone:912-384-6276
Practice Address - Fax:912-389-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048034207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300035710AMedicaid
GAGRP4138Medicare PIN
GAGRP4138Medicare UPIN
GA300035710AMedicaid