Provider Demographics
NPI:1114963337
Name:WATKINS, JOSEPH HOLLAND (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HOLLAND
Last Name:WATKINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2218
Mailing Address - Country:US
Mailing Address - Phone:800-242-1131
Mailing Address - Fax:
Practice Address - Street 1:810 SAINT VINCENTS DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1601
Practice Address - Country:US
Practice Address - Phone:205-939-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081044367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-29921OtherBCBS OF AL PIN
AL051517638OtherARM BCBS #
ALP00268831OtherMEDICARE RAILROAD PIN
AL051554164Medicaid
ALP00078058OtherARM RAILROAD MEDICARE #
ALP00268831OtherMEDICARE RAILROAD PIN
ALP52177Medicare UPIN
AL051554164Medicaid