Provider Demographics
NPI:1407025174
Name:WATKINS, CAROLYN BARNETTE (MA,RD,RN,CDE)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BARNETTE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MA,RD,RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RIDGE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9061
Mailing Address - Country:US
Mailing Address - Phone:803-699-7369
Mailing Address - Fax:803-788-7335
Practice Address - Street 1:700 RIDGE TRAIL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9061
Practice Address - Country:US
Practice Address - Phone:803-699-7369
Practice Address - Fax:803-788-7335
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC716743133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered