Provider Demographics
NPI:1700801826
Name:ATKINS, ERNIE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:LEE
Last Name:ATKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 A ST SE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1100
Mailing Address - Country:US
Mailing Address - Phone:509-787-7662
Mailing Address - Fax:509-787-1976
Practice Address - Street 1:201 A ST SE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1100
Practice Address - Country:US
Practice Address - Phone:509-787-7662
Practice Address - Fax:509-787-1976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP0001372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8145344Medicaid
WA8145344Medicaid
WAG8855486Medicare ID - Type Unspecified