Provider Demographics
NPI:1841485323
Name:COLLINS, WILLIE J
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:J
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:USS THE SULLIVANS
Mailing Address - Street 2:DDG 68
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34093-1287
Mailing Address - Country:US
Mailing Address - Phone:904-270-6291
Mailing Address - Fax:
Practice Address - Street 1:USS THE SULLIVANS
Practice Address - Street 2:DDG68
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34093-1287
Practice Address - Country:US
Practice Address - Phone:904-270-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman