Provider Demographics
NPI:1467447334
Name:ATKINS, BILLY JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:JACK
Last Name:ATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 IH 45 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4958
Mailing Address - Country:US
Mailing Address - Phone:936-295-6436
Mailing Address - Fax:936-295-6616
Practice Address - Street 1:260 IH 45 S
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4958
Practice Address - Country:US
Practice Address - Phone:936-295-6436
Practice Address - Fax:936-295-6616
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4017207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123061701Medicaid
TXD34181Medicare UPIN
TXF765Medicare ID - Type Unspecified