Provider Demographics
NPI:1134294044
Name:MARY E WATKINS DC PC
Entity Type:Organization
Organization Name:MARY E WATKINS DC PC
Other - Org Name:WATKINS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-534-0656
Mailing Address - Street 1:961 GREEN NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3380
Mailing Address - Country:US
Mailing Address - Phone:770-534-0656
Mailing Address - Fax:
Practice Address - Street 1:961 GREEN NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3380
Practice Address - Country:US
Practice Address - Phone:770-534-0656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55000908AMedicaid
GA55000908AMedicaid
GA482883035B-GRP76Medicare ID - Type UnspecifiedCHIROPRACTIC