Healthcare Provider Details

I. General information

NPI: 1598591554
Provider Name (Legal Business Name): WATKINS REJUVENATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 RIVERSIDE DR
MACON GA
31210
US

IV. Provider business mailing address

3160 RIVERSIDE DR
MACON GA
31210
US

V. Phone/Fax

Practice location:
  • Phone: 478-259-3803
  • Fax: 478-259-3543
Mailing address:
  • Phone: 478-259-3803
  • Fax: 478-259-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CONTRESHIA TELRUNNE WATKINS
Title or Position: OFFICE MANAGER/OWNER
Credential:
Phone: 478-259-3803