MEDICARE: SHELIA COLLINS

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	261QA0005X	Ambulatory Family Planning Facility	261QA0600X	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689070021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELIA COLLINS

Provider Business Mailing Address
First Line	:	201 MERCER AVE
Second Line	:
City	:	HOLLANDALE
State	:	MS
Zip	:	38748-3239
Country	:	US
Telephone Number	:	662-827-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 DEER CREEK
Second Line	:
City	:	ARCOLA
State	:	MS
Zip	:	38722-3239
Country	:	US
Telephone Number	:	662-827-0607
Fax Number	:

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

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	11/19/2014

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Directions to “ SHELIA COLLINS ” Practice Location

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