Provider Demographics
NPI:1790540789
Name:ATKINSON, COURTNEY MEGAN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MEGAN
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 JUDGE SEKUL AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2908
Mailing Address - Country:US
Mailing Address - Phone:228-374-8175
Mailing Address - Fax:
Practice Address - Street 1:1070 JUDGE SEKUL AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2908
Practice Address - Country:US
Practice Address - Phone:228-374-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4269-15DH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist