Individual
DR. MICHAEL KEVIN COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
790 CHURCH ST NE STE 400, MARIETTA, GA 30060-8957
(770) 405-2976
Mailing address
PO BOX 3157, INDIANAPOLIS, IN 46206-3157
(770) 405-2976
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
053687
GA
207Q00000X
Family Medicine Physician
053687
GA
2085R0202X
Diagnostic Radiology Physician
Primary
053687
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106988955C
—
GA
01
—
52068609-003
BCBS PROVIDER NUMBER
GA
Enumeration date
10/13/2005
Last updated
08/23/2022
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