Provider Demographics
NPI:1013471556
Name:COLLINS, STONE LAWSON
Entity Type:Individual
Prefix:
First Name:STONE
Middle Name:LAWSON
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 1:800 GSW STATE UNIVERSITY DR # 1166
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4376
Mailing Address - Country:US
Mailing Address - Phone:229-410-9153
Mailing Address - Fax:
Practice Address - Street 1:800 GSW STATE UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4376
Practice Address - Country:US
Practice Address - Phone:229-410-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0036512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty