Provider Demographics
NPI:1770617920
Name:COLLINS, WENDY JOY (DC)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:JOY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4643
Mailing Address - Country:US
Mailing Address - Phone:770-474-7814
Mailing Address - Fax:770-474-7814
Practice Address - Street 1:102 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5049
Practice Address - Country:US
Practice Address - Phone:770-506-4344
Practice Address - Fax:770-506-9414
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGCNMedicare ID - Type Unspecified
GAU81908Medicare UPIN