Provider Demographics
NPI:1336112408
Name:COLLINS, JIMMIE NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:NELSON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8960
Mailing Address - Fax:757-446-5197
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8960
Practice Address - Fax:757-446-5197
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055728208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8905017Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VA-019OtherTRICARE/CHAMPUS
VA14605OtherSENTARA OPTIMA
VA265781OtherUHC/MAMSI
VAPAROtherCIGNA
VAPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA283139OtherANTHEM
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
VA007308663Medicaid
NC05017OtherNC BC/BS
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
VA265781OtherUHC/MAMSI
VAPAROtherAETNA
VA007308663Medicaid