Provider Demographics
NPI:1528876810
Name:COLLINS, CURTIS L
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 GAP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9326
Mailing Address - Country:US
Mailing Address - Phone:864-444-4254
Mailing Address - Fax:
Practice Address - Street 1:1664 GAP CREEK RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-9326
Practice Address - Country:US
Practice Address - Phone:864-444-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0008157148172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty