MEDICARE: MS. BEVERLY ANNE COLLINS MSN, ARNP, FNPC

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	363LF0000X	Family Nurse Practitioner	RN178151 NP	GA
2	363LF0000X	Family Nurse Practitioner	709041 FNP-LPA	TX

General Provider Information

NPI Number	:	1235297474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY ANNE COLLINS MSN, ARNP, FNPC

Provider Business Mailing Address
First Line	:	418 SUNFLOWER RDG
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8523
Country	:	US
Telephone Number	:	770-876-3995
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD., N.E.
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1611
Country	:	US
Telephone Number	:	404-851-6562
Fax Number	:	404-303-3467

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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