Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 11083 | SC |
NPI | 1053383000 |
---|---|
Provider Name | Jonathan C Collins |
First Address | Aiken, SC 29803-5691 |
Second Address | Aiken, SC 29803-6319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110837 | (05) | SC |