MEDICARE: DR. ATIJAH COLLINS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN015448	GA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN015448	GA

General Provider Information

NPI Number	:	1144755976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATIJAH COLLINS D.M.D.

Provider Business Mailing Address
First Line	:	1155 CONCORD RD SE STE 100
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4255
Country	:	US
Telephone Number	:	770-435-9222
Fax Number	:	770-435-9260

Provider Business Practice Location Address
First Line	:	1155 CONCORD RD SE STE 100
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4255
Country	:	US
Telephone Number	:	770-435-9222
Fax Number	:	770-435-9260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2017
Last Update Date	:	04/24/2024

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