Healthcare Provider Details

I. General information

NPI: 1902604978
Provider Name (Legal Business Name): LOGAN MARIE COLLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8046 N BROTHER BLVD STE 103
BARTLETT TN
38133-2762
US

IV. Provider business mailing address

8045 N BROTHER BLVD STE 103
BARTLETT TN
38133-2759
US

V. Phone/Fax

Practice location:
  • Phone: 731-487-8912
  • Fax:
Mailing address:
  • Phone: 901-373-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: