Provider Demographics
NPI:1760710990
Name:BATMAN, ANITA WACHT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:WACHT
Last Name:BATMAN
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 1:117 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-3535
Mailing Address - Country:US
Mailing Address - Phone:662-455-9507
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 82 STUDENT HEALTH CLINIC
Practice Address - Street 2:MISSISSIPPI VALLEY STATE UNIVERSITY
Practice Address - City:ITTA BENA
Practice Address - State:MS
Practice Address - Zip Code:38941
Practice Address - Country:US
Practice Address - Phone:662-254-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine