Individual
DR. LEWIS EMBRY COLLINS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4530 S BERKELEY LAKE RD, STE B, BERKELEY LAKE, GA 30071-1657
(770) 446-5642
(770) 446-5643
Mailing address
4530 S BERKELEY LAKE RD, SUITE B, NORCROSS, GA 30071-1660
(770) 446-5642
(770) 446-5643
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 0892
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000546356B
—
GA
05
—
000546356C
—
GA
Enumeration date
11/21/2006
Last updated
06/01/2017
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