Healthcare Provider Details

I. General information

NPI: 1104912104
Provider Name (Legal Business Name): WILLIAM COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 HIGHWAY 54 WEST SUITE 150
FAYETTEVILLE GA
30214
US

IV. Provider business mailing address

1975 HIGHWAY 54 WEST SUITE 150
FAYETTEVILLE GA
30214
US

V. Phone/Fax

Practice location:
  • Phone: 770-486-5000
  • Fax:
Mailing address:
  • Phone: 770-486-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025129
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: