Provider Demographics
NPI:1912967795
Name:WATKINS, DAWN JAYELYNN (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:JAYELYNN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:MS
Mailing Address - Zip Code:39555-0850
Mailing Address - Country:US
Mailing Address - Phone:228-588-2938
Mailing Address - Fax:228-588-9399
Practice Address - Street 1:7001 HWY 614
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:MS
Practice Address - Zip Code:39555
Practice Address - Country:US
Practice Address - Phone:228-588-2938
Practice Address - Fax:228-588-9399
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238363207Q00000X
MS21648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010259037Medicaid
VA010259037Medicaid
VA009489P95Medicare PIN