Provider Demographics
NPI:1245831403
Name:WATKINS, JULIA PATRICE (CPT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PATRICE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 W BAY AVE # F112
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4564
Mailing Address - Country:US
Mailing Address - Phone:757-355-3247
Mailing Address - Fax:
Practice Address - Street 1:254 W BAY AVE # F112
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-4564
Practice Address - Country:US
Practice Address - Phone:757-355-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172V00000X
VAP2N2E2N3202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health Worker