MEDICARE: TIMOTHY WATKINS NP

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	363L00000X	Nurse Practitioner	1-103700	AL

General Provider Information

NPI Number	:	1770933038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY WATKINS NP

Provider Business Mailing Address
First Line	:	210 FIELDSTOWN RD STE 124
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-2418
Country	:	US
Telephone Number	:	205-285-8252
Fax Number	:	205-285-8262

Provider Business Practice Location Address
First Line	:	210 FIELDSTOWN RD STE 124
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-2418
Country	:	US
Telephone Number	:	205-285-8252
Fax Number	:	205-285-8262

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

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	06/17/2016

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