Provider Demographics
NPI:1700821030
Name:COLLINS, JANICE M
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11090 GLENHURST PASS
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5790
Mailing Address - Country:US
Mailing Address - Phone:678-371-4699
Mailing Address - Fax:
Practice Address - Street 1:11975 MORRIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4419
Practice Address - Country:US
Practice Address - Phone:770-521-2295
Practice Address - Fax:770-255-0333
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117850367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife