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General NPI Number Information
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NPI Number | 1588750723
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Entity Type | Organization
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Legal Business Name | LEWIS R. COLLINS, JR., M.D., P. C.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 1013 E 1ST ST
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City | VIDALIA
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State | GA
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Zip | 30474-4227
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Country | US
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Telephone | 912-538-7702
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Fax | 912-538-9520
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Provider Business Mailing Address
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Address Line | 1013 E 1ST ST
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City | VIDALIA
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State | GA
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Zip | 30474-4227
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Country | US
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Telephone | 912-538-7702
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Fax | 912-538-9520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEWIS R COLLINS JR.
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Credential | MD
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Telephone | 912-354-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 034795
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License Number State | GA
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