Provider Demographics
NPI:1457983546
Name:COLLINS FAMILY & ADDICTION MEDICINE, PLLC
Entity Type:Organization
Organization Name:COLLINS FAMILY & ADDICTION MEDICINE, PLLC
Other - Org Name:BLISSFUL ADDICTION RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-438-7739
Mailing Address - Street 1:4777 ANDREW JACKSON PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1356
Mailing Address - Country:US
Mailing Address - Phone:615-915-2226
Mailing Address - Fax:629-202-7956
Practice Address - Street 1:4777 ANDREW JACKSON PKWY STE 102
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1356
Practice Address - Country:US
Practice Address - Phone:615-915-2226
Practice Address - Fax:629-202-7956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty