Provider Demographics
NPI:1306829817
Name:COLLINS, LAJUANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAJUANA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAJUANA
Other - Middle Name:M
Other - Last Name:COLLINS-MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:72 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6013
Mailing Address - Country:US
Mailing Address - Phone:757-869-2367
Mailing Address - Fax:
Practice Address - Street 1:2244 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2430
Practice Address - Country:US
Practice Address - Phone:757-827-1001
Practice Address - Fax:757-827-3161
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010476972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007113030Medicaid
VA226715OtherANTHEM BC
VA226715OtherANTHEM BC