Provider Demographics
NPI:1326533308
Name:COLLINS, BRADLEY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 2ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7887
Mailing Address - Country:US
Mailing Address - Phone:737-936-9808
Mailing Address - Fax:
Practice Address - Street 1:2001 2ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7887
Practice Address - Country:US
Practice Address - Phone:843-793-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO52061207RR0500X, 207RR0500X
SCLL52061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine