Provider Demographics
NPI:1295205441
Name:WATKINS, ANTOINE (MSW)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 BRIW RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5330
Mailing Address - Country:US
Mailing Address - Phone:530-642-7111
Mailing Address - Fax:
Practice Address - Street 1:3057 BRIW RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5330
Practice Address - Country:US
Practice Address - Phone:916-912-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator