Healthcare Provider Details

I. General information

NPI: 1275009433
Provider Name (Legal Business Name): TEDDY W COLLINGSWORTH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 HARPER ST
AUGUSTA GA
30912-0020
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-4209
  • Fax: 706-721-1794
Mailing address:
  • Phone: 706-736-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN227420
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: