Provider Demographics
NPI:1164204988
Name:WATKINS, BROOKE GOODSON (AUD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:GOODSON
Last Name:WATKINS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 HIDDEN FOREST CT UNIT 3211
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3148
Mailing Address - Country:US
Mailing Address - Phone:334-648-1907
Mailing Address - Fax:
Practice Address - Street 1:6002 PROFESSIONAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5603
Practice Address - Country:US
Practice Address - Phone:770-949-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist