Healthcare Provider Details

I. General information

NPI: 1982993002
Provider Name (Legal Business Name): JEFFREY M COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 PONCE DE LEON AVE NE
ATLANTA GA
30308
US

IV. Provider business mailing address

550 PEACHTREE ST NE 7TH FLOOR
ATLANTA GA
30308-2212
US

V. Phone/Fax

Practice location:
  • Phone: 734-657-0240
  • Fax:
Mailing address:
  • Phone: 734-657-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number73963
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: