Provider Demographics
NPI:1083624365
Name:COLLINS, SIDNEY W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:W
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK BLVD, 250 WEST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-844-6620
Mailing Address - Fax:423-844-6626
Practice Address - Street 1:1 MEDICAL PARK BLVD, 250 WEST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-844-6620
Practice Address - Fax:423-844-6626
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5311208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN40441OtherMEDICAL LICENSE