Healthcare Provider Details

I. General information

NPI: 1114982956
Provider Name (Legal Business Name): JEFFREY W COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 05/31/2024
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEIGHTON AVE SUITE 501
ANNISTON AL
36207-5765
US

IV. Provider business mailing address

901 LEIGHTON AVE SUITE 501
ANNISTON AL
36207-5765
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-6755
  • Fax: 256-236-1823
Mailing address:
  • Phone: 256-237-6755
  • Fax: 256-236-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number21700
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number21700
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number21700
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: