Provider Demographics
NPI:1083486542
Name:COLLINS, DEREK II (NP)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:COLLINS
Suffix:II
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ASHLEY PARK DR APT F304
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-3255
Mailing Address - Country:US
Mailing Address - Phone:954-864-0908
Mailing Address - Fax:
Practice Address - Street 1:145 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2079
Practice Address - Country:US
Practice Address - Phone:912-283-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine