Provider Demographics
NPI:1003073628
Name:COLLINSWORTH, AMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:COLLINSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 NORTHSHORE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118
Mailing Address - Country:US
Mailing Address - Phone:501-225-1400
Mailing Address - Fax:501-225-1401
Practice Address - Street 1:4850 NORTHSHORE LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118
Practice Address - Country:US
Practice Address - Phone:501-225-1400
Practice Address - Fax:501-225-1401
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202964207ZP0102X
NC2018-00213207ZP0102X
FLME113275207ZP0102X
ARE-11085207ZP0102X
GA79531207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006741900Medicaid
FLGT922ZMedicare PIN