Provider Demographics
NPI:1053606798
Name:WATKINS-GILLHAM, JAIME MELINDA
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MELINDA
Last Name:WATKINS-GILLHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51322
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5622
Mailing Address - Country:US
Mailing Address - Phone:270-777-9283
Mailing Address - Fax:270-777-9283
Practice Address - Street 1:130 CANAL ST
Practice Address - Street 2:BUILDING 400
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4085
Practice Address - Country:US
Practice Address - Phone:912-988-1444
Practice Address - Fax:803-905-4431
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-02-0531103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst