Provider Demographics
NPI:1255369005
Name:WATKINS, HAROLD MICHAEL
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:MICHAEL
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 1:620 J L WHITE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JASPE
Mailing Address - State:GA
Mailing Address - Zip Code:30142
Mailing Address - Country:US
Mailing Address - Phone:706-253-1305
Mailing Address - Fax:706-253-1306
Practice Address - Street 1:620 J L WHITE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JASPE
Practice Address - State:GA
Practice Address - Zip Code:30142
Practice Address - Country:US
Practice Address - Phone:706-253-1305
Practice Address - Fax:706-253-1306
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA121327565AMedicaid
GAQ41408Medicare UPIN