Provider Demographics
NPI:1114982956
Name:COLLINS, JEFFREY W (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0632
Mailing Address - Country:US
Mailing Address - Phone:256-294-7010
Mailing Address - Fax:256-405-1138
Practice Address - Street 1:901 LEIGHTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5703
Practice Address - Country:US
Practice Address - Phone:256-294-7010
Practice Address - Fax:256-405-1138
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21700207VG0400X, 207VX0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL218370Medicaid
ALG64388Medicare UPIN
AL051503974Medicaid