Provider Demographics
NPI:1992858278
Name:COLLINS, BILLY ST JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:ST JOHN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:441 SOMMERSET WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9200
Mailing Address - Country:US
Mailing Address - Phone:252-535-8463
Mailing Address - Fax:
Practice Address - Street 1:240 SMITH CHURCH RD STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4900
Practice Address - Country:US
Practice Address - Phone:252-535-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical