Provider Demographics
NPI:1750993994
Name:COLLINS, JOHN IRVING
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:IRVING
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ANGLES HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630-8065
Mailing Address - Country:US
Mailing Address - Phone:304-910-2210
Mailing Address - Fax:
Practice Address - Street 1:180 ANGLES HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630-8065
Practice Address - Country:US
Practice Address - Phone:304-910-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant