Provider Demographics
NPI:1851311856
Name:WATKINS, CLYDE JR (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:
Last Name:WATKINS
Suffix:JR
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 HILLANDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058
Mailing Address - Country:US
Mailing Address - Phone:404-446-3870
Mailing Address - Fax:404-446-3875
Practice Address - Street 1:5900 HILLANDALE DRIVE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:404-446-3870
Practice Address - Fax:404-446-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2676968914AMedicaid
GA01BDHVCMedicare ID - Type Unspecified
GA2676968914AMedicaid