Healthcare Provider Details

I. General information

NPI: 1134294044
Provider Name (Legal Business Name): MARY E WATKINS DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 GREEN NE
GAINESVILLE GA
30501-3380
US

IV. Provider business mailing address

961 GREEN NE
GAINESVILLE GA
30501-3380
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-0656
  • Fax:
Mailing address:
  • Phone: 770-534-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR002484
License Number StateGA

VIII. Authorized Official

Name: DR. MARY ELIZABETH WATKINS
Title or Position: DOCTOR
Credential: DC
Phone: 770-534-0656