Healthcare Provider Details

I. General information

NPI: 1457983546
Provider Name (Legal Business Name): COLLINS FAMILY & ADDICTION MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4777 ANDREW JACKSON PKWY STE 102
HERMITAGE TN
37076-1356
US

IV. Provider business mailing address

4777 ANDREW JACKSON PKWY STE 102
HERMITAGE TN
37076-1356
US

V. Phone/Fax

Practice location:
  • Phone: 615-915-2226
  • Fax: 629-202-7956
Mailing address:
  • Phone: 615-915-2226
  • Fax: 629-202-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY COLLINS
Title or Position: OWNER
Credential: MD
Phone: 615-438-7739