Provider Demographics
NPI:1730626078
Name:COLLINS, LAVINIA (LMT)
Entity type:Individual
Prefix:
First Name:LAVINIA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1689
Mailing Address - Country:US
Mailing Address - Phone:770-569-3145
Mailing Address - Fax:
Practice Address - Street 1:7100 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1689
Practice Address - Country:US
Practice Address - Phone:770-569-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist