Healthcare Provider Details

I. General information

NPI: 1386870426
Provider Name (Legal Business Name): MARTHA LOUISE COLLINS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 E MAIN ST SUITE B
GALLATIN TN
37066-2961
US

IV. Provider business mailing address

258 E MAIN ST SUITE B
GALLATIN TN
37066-2961
US

V. Phone/Fax

Practice location:
  • Phone: 615-575-4176
  • Fax: 615-452-9652
Mailing address:
  • Phone: 615-575-4176
  • Fax: 615-452-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number2971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: