Provider Demographics
NPI:1447250220
Name:COLLINS, ROBERT DARRELL (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DARRELL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2109
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2109
Mailing Address - Country:US
Mailing Address - Phone:912-384-6276
Mailing Address - Fax:912-389-1618
Practice Address - Street 1:1400 PETERSON AVE N STE C
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2833
Practice Address - Country:US
Practice Address - Phone:912-384-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48034207R00000X, 207RC0000X
GA048034207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000842696EMedicaid
GAG46653Medicare UPIN
GA000842696EMedicaid