Healthcare Provider Details

I. General information

NPI: 1346514650
Provider Name (Legal Business Name): WATKINS TOTAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 GREEN ST NW
GAINESVILLE GA
30501-3325
US

IV. Provider business mailing address

961 GREEN ST NW
GAINESVILLE GA
30501-3325
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. JEANNE HANLIN
Title or Position: MANAGER
Credential:
Phone: 770-534-0656