Individual
ANDREA JEMAE COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7008
Mailing address
960 AVENT DR, GRENADA, MS 38901-5230
(662) 227-7008
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
T-2417
MS
208M00000X
Hospitalist Physician
Primary
22307
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00028386
—
MS
01
—
P01764009
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/01/2011
Last updated
02/06/2017
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