MEDICARE: DR. MARSHALL JAMES COLLINS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN015500	GA

General Provider Information

NPI Number	:	1336650670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL JAMES COLLINS DDS

Provider Business Mailing Address
First Line	:	450 PIEDMONT AVE NE APT 2105
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 PIEDMONT RD NE STE 230
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-4810
Country	:	US
Telephone Number	:	404-233-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	03/17/2018

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