Provider Demographics
NPI:1437444122
Name:WATKINS, JESHENNA JAMILL (MD)
Entity Type:Individual
Prefix:
First Name:JESHENNA
Middle Name:JAMILL
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CHAMBRAY HLS
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4246
Mailing Address - Country:US
Mailing Address - Phone:901-355-0361
Mailing Address - Fax:
Practice Address - Street 1:190 HANDLEY RD STE A
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2178
Practice Address - Country:US
Practice Address - Phone:770-997-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53213207V00000X
GA85013207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6046398OtherBCBS
TNQ014860Medicaid
TN6046398OtherBCBS