Healthcare Provider Details

I. General information

NPI: 1831172493
Provider Name (Legal Business Name): RAYMOND CRAIG COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 MITCHELL ST
LORIS SC
29569-2827
US

IV. Provider business mailing address

PO BOX 602437
CHARLOTTE NC
28260-2437
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-7000
  • Fax: 706-660-9390
Mailing address:
  • Phone: 800-329-9156
  • Fax: 706-660-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20803
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20803
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: