Healthcare Provider Details

I. General information

NPI: 1336650670
Provider Name (Legal Business Name): MARSHALL JAMES COLLINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 THORNTON RD
LITHIA SPRINGS GA
30122-1591
US

IV. Provider business mailing address

1665 DUNCAN DR NW
ATLANTA GA
30318-2738
US

V. Phone/Fax

Practice location:
  • Phone: 770-745-5886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015500
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: