Provider Demographics
NPI:1255339941
Name:COLLINS, LARRY COY (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:COY
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3990
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-3990
Mailing Address - Country:US
Mailing Address - Phone:423-479-6214
Mailing Address - Fax:423-614-4405
Practice Address - Street 1:2370 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3850
Practice Address - Country:US
Practice Address - Phone:423-479-6214
Practice Address - Fax:423-614-4405
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN118742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3042106Medicaid
TN3042106Medicaid
TND93151Medicare UPIN