Healthcare Provider Details

I. General information

NPI: 1659205888
Provider Name (Legal Business Name): JIMMY ATKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BOULEVARD PARK E
MOBILE AL
36609-3425
US

IV. Provider business mailing address

505 BOULEVARD PARK E
MOBILE AL
36609-3425
US

V. Phone/Fax

Practice location:
  • Phone: 251-395-6456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-543891
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: