Provider Demographics
NPI:1326127028
Name:COLLINS, NICHOLAS J
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:COLLINS
Suffix:
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 1:400 GEORGIA AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3866
Mailing Address - Country:US
Mailing Address - Phone:985-516-9483
Mailing Address - Fax:985-732-3521
Practice Address - Street 1:400 GEORGIA AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3866
Practice Address - Country:US
Practice Address - Phone:985-516-9483
Practice Address - Fax:985-732-3521
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36196052K332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies