Healthcare Provider Details

I. General information

NPI: 1740728591
Provider Name (Legal Business Name): BRIAN GREGORY COLLINS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

IV. Provider business mailing address

2277 MARTHA BERRY HWY NW 233 MORGAN-BAILEY HALL
MOUNT BERRY GA
30149-9707
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-5000
  • Fax:
Mailing address:
  • Phone: 706-238-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: