Healthcare Provider Details

I. General information

NPI: 1982818282
Provider Name (Legal Business Name): JOE G. COLLINS, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5903 RIDGEWOOD RD SUITE 220
JACKSON MS
39211-3700
US

IV. Provider business mailing address

8 SANDALWOOD DR
MADISON MS
39110-9252
US

V. Phone/Fax

Practice location:
  • Phone: 601-899-3371
  • Fax: 601-898-3993
Mailing address:
  • Phone: 601-856-7170
  • Fax: 601-898-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberENDO 4-77
License Number StateMS

VIII. Authorized Official

Name: MRS. ELIZABETH A. COLLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-856-7170