Kenneth Ray Collins Jr., D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

012476 Issued in GA

Practice address

100 Carnegie PL
Suite 108
Fayetteville, GA 30214-3905

Phone

(770) 461-0188

Fax

(770) 461-0488

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114006020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CARNEGIE PL",
            "address_2": "SUITE 108",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143905",
            "telephone_number": "770-461-0188",
            "fax_number": "770-461-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CARNEGIE PL",
            "address_2": "SUITE 108",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143905",
            "telephone_number": "770-461-0188",
            "fax_number": "770-461-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "KENNETH",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "012476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Lorraine Coley, COTA/L
• Rae Sansom Coley, LCSW
• Collaborative Professional Services
• Derek Collins II, NP
• Jason Collins
• William Collins, MD
• Colorectal Wellness Center LLC
• Comfort Medical Supply LLC
• Community Pharmacy, Inc.
• Community Wellness and Intervention

• Oral and Maxillofacial Surgery (Dentist) in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.