Provider Demographics
NPI:1790928844
Name:WATKISS, AMY ODOM (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ODOM
Last Name:WATKISS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 GEORGIAN PARK
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6973
Mailing Address - Country:US
Mailing Address - Phone:770-632-8909
Mailing Address - Fax:
Practice Address - Street 1:1401 GEORGIAN PARK
Practice Address - Street 2:SUITE 200
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6973
Practice Address - Country:US
Practice Address - Phone:770-632-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-18
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily