Provider Demographics
NPI:1558406553
Name:COLLINS, JIMMY E JR (DPH)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:E
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DERBYSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1083
Mailing Address - Country:US
Mailing Address - Phone:423-587-8855
Mailing Address - Fax:
Practice Address - Street 1:1034 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-4257
Practice Address - Country:US
Practice Address - Phone:865-993-4074
Practice Address - Fax:865-993-4194
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist