Provider Demographics
NPI:1245389006
Name:COLLINS CARDIOLOGY
Entity Type:Organization
Organization Name:COLLINS CARDIOLOGY
Other - Org Name:ROBERT D COLLINS DO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-424-7273
Mailing Address - Street 1:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2109
Mailing Address - Country:US
Mailing Address - Phone:912-384-6276
Mailing Address - Fax:912-383-6365
Practice Address - Street 1:182 PERRY HOUSE RD STE D
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8721
Practice Address - Country:US
Practice Address - Phone:229-424-7273
Practice Address - Fax:229-424-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL048034207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4138Medicare ID - Type Unspecified
GAG46653Medicare UPIN