Provider Demographics
NPI:1760955694
Name:COLLINS, CALE CARLTON
Entity Type:Individual
Prefix:
First Name:CALE
Middle Name:CARLTON
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 CINNAMON FERN LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6910
Mailing Address - Country:US
Mailing Address - Phone:678-234-3989
Mailing Address - Fax:
Practice Address - Street 1:4007 CINNAMON FERN LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6910
Practice Address - Country:US
Practice Address - Phone:678-234-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator