Provider Demographics
NPI:1194178186
Name:COLLINS, WILLIE JR
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 E JEFFERSON AVE
Mailing Address - Street 2:C810
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3967
Mailing Address - Country:US
Mailing Address - Phone:973-841-3520
Mailing Address - Fax:
Practice Address - Street 1:8104 E JEFFERSON AVE
Practice Address - Street 2:C810
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3967
Practice Address - Country:US
Practice Address - Phone:973-841-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other