Provider Demographics
NPI:1740867795
Name:COLLINSWORTH, JENNIFER RUTT (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTT
Last Name:COLLINSWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:RUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE A120
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6305
Practice Address - Country:US
Practice Address - Phone:864-454-2670
Practice Address - Fax:864-454-2679
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-01477208000000X
NC390200000X
SC94466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program