| L. Embry Collins, Jr., Phd, P.c. | |
|
4530 S Berkeley Lake Rd Suite B Norcross GA 30071-1660 | |
| (770) 446-5642 | |
| (770) 446-5643 |
| Full Name | L. Embry Collins, Jr., Phd, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4530 S Berkeley Lake Rd, Norcross, Georgia |
| Authorized Official Name and Position | Lewis Embry Collins (PSYCHOLOGIST) |
| Authorized Official Contact | 7704465642 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| L. Embry Collins, Jr., Phd, P.c. 4530 S Berkeley Lake Rd Suite B Norcross GA 30071-1660 Ph: (770) 446-5642 | L. Embry Collins, Jr., Phd, P.c. 4530 S Berkeley Lake Rd Suite B Norcross GA 30071-1660 Ph: (770) 446-5642 |
| NPI Number | 1215169883 |
|---|---|
| Provider Enumeration Date | 08/17/2009 |
| Last Update Date | 08/17/2009 |
| Medicare PECOS PAC ID | 3870648850 |
|---|---|
| Medicare Enrollment ID | O20090826000677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215169883 | NPI | - | NPPES |
| 000546356C | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | PSY 0892 (Georgia) | Primary |
| Provider Name | Lewis E Collins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235204991 PECOS PAC ID: 1355496332 Enrollment ID: I20090826000662 |
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