Provider Demographics
NPI:1982674396
Name:COLLINS, AMIE N (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:N
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:AMIE
Other - Middle Name:N
Other - Last Name:RACINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-8000
Mailing Address - Fax:910-615-5715
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-8000
Practice Address - Fax:910-615-5715
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20906207P00000X
NC2007-01797207R00000X, 208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2425941Medicaid
NC5908077Medicaid
WVCO7334771Medicare ID - Type Unspecified
NC5908077Medicaid
H83958Medicare UPIN