Provider Demographics
NPI:1679669840
Name:COLLINS, LEWIS R JR (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:R
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1013 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4227
Mailing Address - Country:US
Mailing Address - Phone:912-538-7702
Mailing Address - Fax:912-538-9520
Practice Address - Street 1:4849 PAULSEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4423
Practice Address - Country:US
Practice Address - Phone:912-354-7546
Practice Address - Fax:912-354-7558
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034795207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5257583OtherBLUE CROSS BLUE SHIELD GA
G05382Medicare UPIN
GA07BBCRNMedicare ID - Type Unspecified