MEDICARE: DARRICE COLLINS D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	59.000515	OH
2	213ES0103X	Foot & Ankle Surgery Podiatrist	36.003886	OH
3	213ES0103X	Foot & Ankle Surgery Podiatrist	POD001419	GA

General Provider Information

NPI Number	:	1760802268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRICE COLLINS D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 WHITE SULPHUR RD STE 120
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2569
Country	:	US
Telephone Number	:	770-219-0963
Fax Number	:	770-219-0959

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	01/31/2024

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