Provider Demographics
NPI:1508376237
Name:WATKINS, RONALD DARYL
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DARYL
Last Name:WATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-8942
Mailing Address - Country:US
Mailing Address - Phone:601-624-3484
Mailing Address - Fax:
Practice Address - Street 1:8229 BUTLER RD
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-8942
Practice Address - Country:US
Practice Address - Phone:601-624-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other