Provider Demographics
NPI:1245275353
Name:ROSS E. COLLINS, JR. M.D.
Entity type:Organization
Organization Name:ROSS E. COLLINS, JR. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:901-854-8727
Mailing Address - Street 1:311 POPLAR VIEW LN W
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3175
Mailing Address - Country:US
Mailing Address - Phone:901-854-8727
Mailing Address - Fax:901-854-8595
Practice Address - Street 1:311 POPLAR VIEW LN W
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3175
Practice Address - Country:US
Practice Address - Phone:901-854-8727
Practice Address - Fax:901-854-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000163592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010869Medicaid
MS3046799Medicare ID - Type Unspecified
MS00010869Medicaid