Healthcare Provider Details

I. General information

NPI: 1477501047
Provider Name (Legal Business Name): SONYA R COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

2692 MADISON RD STE N1110
CINCINNATI OH
45208-1321
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6011
  • Fax:
Mailing address:
  • Phone: 423-326-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.135833
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number31281
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number56979
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number36394
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: