MEDICARE: NERKA LAVETTE WATKINS-GRAHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	046922	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619938198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERKA LAVETTE WATKINS-GRAHAM MD

Provider Business Mailing Address
First Line	:	134 RIVERSTONE TERRACE
Second Line	:	SUITE 103
City	:	CANTON
State	:	GA
Zip	:	30114-1705
Country	:	US
Telephone Number	:	770-479-1985
Fax Number	:	770-479-4839

Provider Business Practice Location Address
First Line	:	134 RIVERSTONE TERRACE
Second Line	:	SUITE 103
City	:	CANTON
State	:	GA
Zip	:	30114-1705
Country	:	US
Telephone Number	:	770-479-1985
Fax Number	:	770-479-4839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	03/17/2016

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