Healthcare Provider Details

I. General information

NPI: 1235126392
Provider Name (Legal Business Name): TIMOTHY JAMES COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 GRADY RD SUITE B
ETOWAH TN
37331-1903
US

IV. Provider business mailing address

305 GRADY RD SUITE B
ETOWAH TN
37331-1903
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-0722
  • Fax: 423-263-5232
Mailing address:
  • Phone: 423-263-0722
  • Fax: 423-263-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30261
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: