Healthcare Provider Details

I. General information

NPI: 1760692917
Provider Name (Legal Business Name): CHRISTINA D COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MARIE DEVILLIER MD

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FIFTH STREET, NORTH
COLUMBUS MS
39705
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 662-244-2960
  • Fax: 662-244-2917
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20660
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20660
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: