Provider Demographics
NPI:1265643191
Name:TAMMY COLLINS MD PC
Entity Type:Organization
Organization Name:TAMMY COLLINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-443-7990
Mailing Address - Street 1:404 CASTLE HEIGHTS AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3805
Mailing Address - Country:US
Mailing Address - Phone:615-443-7990
Mailing Address - Fax:615-453-1585
Practice Address - Street 1:404 CASTLE HEIGHTS AVE N
Practice Address - Street 2:SUITE F
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3805
Practice Address - Country:US
Practice Address - Phone:615-443-7990
Practice Address - Fax:615-453-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710805Medicare ID - Type Unspecified