Healthcare Provider Details

I. General information

NPI: 1689665895
Provider Name (Legal Business Name): JOCELYN DAISY COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/13/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOUNT ZION PKWY SOUTHWOOD MEDICAL CENTER DEPARTMENT OF AFTER HOURS
JONESBORO GA
30236-2500
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-3704
  • Fax:
Mailing address:
  • Phone: 404-949-5019
  • Fax: 404-364-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number050145
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number050145
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: