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General NPI Number Information
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NPI Number | 1871581728
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Entity Type | Individual
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Provider Name | GEORGE ROBERT COLLINS D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 211 4TH ST
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8421
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Country | US
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Telephone | 318-769-3219
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3780
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City | TUPELO
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State | MS
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Zip | 38803-3780
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Country | US
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Telephone | 318-841-9526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | L7338
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | DO.000178
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License Number State | LA
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