Provider Demographics
NPI:1780775643
Name:COLLINS, SEAN (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
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 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-875-6151
Mailing Address - Fax:615-936-3754
Practice Address - Street 1:1313 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4700
Practice Address - Country:US
Practice Address - Phone:615-875-6151
Practice Address - Fax:615-936-3754
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075451207P00000X
TNMD47458207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2120707Medicaid
OHCO4051031Medicare ID - Type Unspecified
OH2120707Medicaid