Derek Collins II, NP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

GAA-NP001489 Issued in GA

Practice address

145 Johnson Ave
Fayetteville, GA 30214-2079

Phone

(912) 283-5260

NPI assigned

Oct 26, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1083486542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 ASHLEY PARK DR APT F304",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302633255",
            "telephone_number": "954-864-0908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 JOHNSON AVE",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302142079",
            "telephone_number": "912-283-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "DEREK",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-26",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "GAA-NP001489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Santonia Coleman, CPT
• Curtis James Coley II, MD
• Melissa Lorraine Coley, COTA/L
• Rae Sansom Coley, LCSW
• Collaborative Professional Services
• Jason Collins
• Kenneth Ray Collins Jr., D.D.S.
• William Collins, MD
• Colorectal Wellness Center LLC
• Comfort Medical Supply LLC

• Family Medicine Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.