Healthcare Provider Details

I. General information

NPI: 1760433288
Provider Name (Legal Business Name): JESSICA ELLA COLLINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MEDICAL CENTER DR STE B
COPPERHILL TN
37317-5005
US

IV. Provider business mailing address

144 MEDICAL CENTER DR STE B
COPPERHILL TN
37317-5005
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-9214
  • Fax: 423-496-7809
Mailing address:
  • Phone: 423-496-9214
  • Fax: 423-496-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004460
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000003154
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: