Healthcare Provider Details

I. General information

NPI: 1710548037
Provider Name (Legal Business Name): ANN BELTON COLLINS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 MOUNTAIN VIEW RD STE 109
OOLTEWAH TN
37363-6685
US

IV. Provider business mailing address

6401 MOUNTAIN VIEW RD STE 109
OOLTEWAH TN
37363-6685
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-5951
  • Fax: 423-495-5999
Mailing address:
  • Phone: 423-495-5951
  • Fax: 423-495-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00000
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberDO.2781
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4979R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: