Provider Demographics
NPI:1922716554
Name:WATKINS, SAMUEL ROGERS
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ROGERS
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 1:2719 CHATFORD HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1469
Mailing Address - Country:US
Mailing Address - Phone:832-628-5019
Mailing Address - Fax:
Practice Address - Street 1:2633 TRAILING VINE RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7716
Practice Address - Country:US
Practice Address - Phone:281-891-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator