Provider Demographics
NPI:1437144656
Name:BULLOCK WATKINS, DEANN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANN
Middle Name:M
Last Name:BULLOCK WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEANN
Other - Middle Name:MARIE
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1818 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2918
Mailing Address - Country:US
Mailing Address - Phone:615-341-4363
Mailing Address - Fax:
Practice Address - Street 1:1818 ALBION ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2918
Practice Address - Country:US
Practice Address - Phone:615-341-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I27325Medicare UPIN
TN30003322Medicare UPIN
NC2038676Medicare ID - Type Unspecified
TN3370244Medicare PIN