Provider Demographics
NPI:1255840492
Name:WATKINS, AUSTIN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HAMILTON HILL DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3392
Mailing Address - Country:US
Mailing Address - Phone:256-226-1251
Mailing Address - Fax:
Practice Address - Street 1:5736 MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7503
Practice Address - Country:US
Practice Address - Phone:931-815-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27291363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health