Provider Demographics
NPI:1023071776
Name:COLLINS, KATIE SHELNUTT (MS, ATC/L)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:SHELNUTT
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SHADEWELL LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5694
Mailing Address - Country:US
Mailing Address - Phone:770-266-2864
Mailing Address - Fax:
Practice Address - Street 1:1205 SHADWELL LANE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-266-2864
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0009902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA22Medicare UPIN