Provider Demographics
NPI:1356339352
Name:COLLINS, SHARON MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MITCHELL
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:P O BOX 424
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2021
Mailing Address - Country:US
Mailing Address - Phone:601-876-5337
Mailing Address - Fax:601-876-5190
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2021
Practice Address - Country:US
Practice Address - Phone:601-876-5337
Practice Address - Fax:601-876-5190
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12466173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5010127OtherAETNA
MS0130137OtherUNITED HEALTHCARE
MS0011131Medicaid
MS0011131Medicaid
MS080003252Medicare ID - Type UnspecifiedMEDICARE #
MS5010127OtherAETNA