Provider Demographics
NPI:1326665167
Name:WATKINS, TERRI L (MSN RN CCM)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MSN RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 COBBLESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7328
Mailing Address - Country:US
Mailing Address - Phone:614-589-7104
Mailing Address - Fax:
Practice Address - Street 1:2102 COBBLESTONE BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7328
Practice Address - Country:US
Practice Address - Phone:614-589-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN256790163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty