Provider Demographics
NPI:1841555992
Name:WATKINS, COLENE L (PA-C)
Entity type:Individual
Prefix:MS
First Name:COLENE
Middle Name:L
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COLENE
Other - Middle Name:L
Other - Last Name:BOWERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1300 HOSPITAL DRIVE SUITE 220
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3538
Mailing Address - Country:US
Mailing Address - Phone:843-936-6238
Mailing Address - Fax:843-936-6239
Practice Address - Street 1:1300 HOSPITAL DRIVE SUITE 220
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3538
Practice Address - Country:US
Practice Address - Phone:843-936-6238
Practice Address - Fax:843-936-6239
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1802363A00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1492PAMedicaid
SCAA9910Medicare UPIN