Provider Demographics
NPI:1629891502
Name:COLLINS, ANSLEE MORGAN
Entity type:Individual
Prefix:
First Name:ANSLEE
Middle Name:MORGAN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 FITZGERALD HWY
Mailing Address - Street 2:
Mailing Address - City:BROXTON
Mailing Address - State:GA
Mailing Address - Zip Code:31519-3244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1432 FITZGERALD HWY
Practice Address - Street 2:
Practice Address - City:BROXTON
Practice Address - State:GA
Practice Address - Zip Code:31519-3244
Practice Address - Country:US
Practice Address - Phone:912-592-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant