Individual
DR. CLINTON WOOD COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, DIVISION OF UROLOGY, JACKSON, MS 39216
(601) 984-5186
(601) 984-5110
Mailing address
2500 N STATE ST, DIVISION OF UROLOGY, JACKSON, MS 39216
(601) 984-5186
(601) 984-5110
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
0101250371
VA
208800000X
Urology Physician
205946
LA
208800000X
Urology Physician
Primary
21716
MS
208800000X
Urology Physician
TL33026
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02504711
—
MS
05
—
134224
—
MS
01
—
P01071194
RAILROAD MEDICARE
MS
Enumeration date
05/22/2007
Last updated
04/01/2013
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