Healthcare Provider Details

I. General information

NPI: 1801722962
Provider Name (Legal Business Name): MIRANDA WATKINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121A BELLEVUE RD BLDG 1
DUBLIN GA
31021-2998
US

IV. Provider business mailing address

770 ISAAC WATKINS RD
MONTROSE GA
31065-3303
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1190
  • Fax:
Mailing address:
  • Phone: 478-272-1190
  • Fax: 470-519-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW013176
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: