Healthcare Provider Details

I. General information

NPI: 1982602504
Provider Name (Legal Business Name): ROBERT S COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 HIGHWAY 28 STE 102
JASPER TN
37347-3695
US

IV. Provider business mailing address

980 HIGHWAY 28 SUITE 102
JASPER TN
37347-3695
US

V. Phone/Fax

Practice location:
  • Phone: 423-942-2851
  • Fax: 423-942-3049
Mailing address:
  • Phone: 423-942-2851
  • Fax: 423-942-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD 16256
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD 16256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: