Provider Demographics
NPI:1053515189
Name:WATKINS, JAMES A (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:WATKINS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9550
Mailing Address - Country:US
Mailing Address - Phone:731-217-3694
Mailing Address - Fax:731-988-3994
Practice Address - Street 1:931 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4458
Practice Address - Country:US
Practice Address - Phone:731-988-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT002673171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00777OtherPSS PROVIDER-DMRS