Healthcare Provider Details

I. General information

NPI: 1720955651
Provider Name (Legal Business Name): MATTHEW COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MALL BLVD STE 100
SAVANNAH GA
31406-4758
US

IV. Provider business mailing address

5300 BULL ST UNIT 215
SAVANNAH GA
31405-5197
US

V. Phone/Fax

Practice location:
  • Phone: 912-200-9158
  • Fax:
Mailing address:
  • Phone: 865-659-4340
  • Fax: 865-659-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number60802
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH.60802PH
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: