Provider Demographics
NPI:1588750723
Name:LEWIS R. COLLINS, JR., M.D., P. C.
Entity type:Organization
Organization Name:LEWIS R. COLLINS, JR., M.D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-7546
Mailing Address - Street 1:1013 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4227
Mailing Address - Country:US
Mailing Address - Phone:912-538-7702
Mailing Address - Fax:912-538-9520
Practice Address - Street 1:1013 E 1ST ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4227
Practice Address - Country:US
Practice Address - Phone:912-538-7702
Practice Address - Fax:912-538-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034795207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4418Medicare ID - Type Unspecified