Provider Demographics
NPI:1629043476
Name:COLLINS, PATRICK WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:675 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5014
Practice Address - Country:US
Practice Address - Phone:865-453-2039
Practice Address - Fax:865-453-3536
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810013716Medicaid
KY64120520Medicaid
OH2891269Medicaid
KY0588667Medicare PIN
OH00772025Medicare PIN