Healthcare Provider Details

I. General information

NPI: 1093120537
Provider Name (Legal Business Name): PAIGE WATKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 CHAPEL HILL RD
DOUGLASVILLE GA
30135-4206
US

IV. Provider business mailing address

4106 CHAPEL HILL RD
DOUGLASVILLE GA
30135-4206
US

V. Phone/Fax

Practice location:
  • Phone: 404-375-9089
  • Fax: 770-489-1857
Mailing address:
  • Phone: 404-375-9089
  • Fax: 770-489-1857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN127979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: