Healthcare Provider Details

I. General information

NPI: 1699774752
Provider Name (Legal Business Name): RUFUS W WATKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MEDICAL RIDGE RD
CLINTON SC
29325-4542
US

IV. Provider business mailing address

1012 MEDICAL RIDGE RD
CLINTON SC
29325-4542
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-3852
  • Fax: 864-938-0501
Mailing address:
  • Phone: 864-833-3852
  • Fax: 864-938-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7010
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: