Provider Demographics
NPI:1467633511
Name:COLLINS, BRANDY MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:MICHELLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PLANTATION RIDGE DR APT D
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-5282
Mailing Address - Country:US
Mailing Address - Phone:229-474-6933
Mailing Address - Fax:
Practice Address - Street 1:100 PLANTATION RIDGE DR APT D
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-5282
Practice Address - Country:US
Practice Address - Phone:229-474-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004223363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ22426Medicare UPIN
GA511I970109Medicare PIN