Healthcare Provider Details

I. General information

NPI: 1144840539
Provider Name (Legal Business Name): TONETTA M COLLINS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2020
Last Update Date: 04/25/2020
Certification Date: 04/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 THE EXCHANGE, BLDG 100 SUITE 180
ATLANTA GA
30339-3033
US

IV. Provider business mailing address

2048 LAWRENCEVILLE HWY UNIT 33771
DECATUR GA
30033-6207
US

V. Phone/Fax

Practice location:
  • Phone: 770-575-9393
  • Fax:
Mailing address:
  • Phone: 678-315-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: