Provider Demographics
NPI:1871545475
Name:COLLINS, ALEX DENEZ (DO)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DENEZ
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9481
Mailing Address - Country:US
Mailing Address - Phone:706-210-7529
Mailing Address - Fax:706-312-7610
Practice Address - Street 1:211 HIGH GATE LOOP
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3921
Practice Address - Country:US
Practice Address - Phone:803-265-8117
Practice Address - Fax:803-265-2502
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05736207X00000X
SC987207XX0005X, 207X00000X
GA055736207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA983979031AMedicaid
SC983979031AMedicaid
SC983979031AMedicaid
GA983979031AMedicaid
GA20NCCKMMedicare PIN