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General NPI Number Information
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NPI Number | 1982818282
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Entity Type | Organization
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Legal Business Name | JOE G. COLLINS, D.D.S., P.A.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5903 RIDGEWOOD RD SUITE 220
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City | JACKSON
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State | MS
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Zip | 39211-3700
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Country | US
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Telephone | 601-899-3371
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Fax | 601-898-3993
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Provider Business Mailing Address
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Address Line | 8 SANDALWOOD DR
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City | MADISON
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State | MS
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Zip | 39110-9252
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Country | US
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Telephone | 601-856-7170
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Fax | 601-898-3993
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELIZABETH A. COLLINS
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Credential |
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Telephone | 601-856-7170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | ENDO 4-77
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License Number State | MS
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