=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679726277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRY DANIEL WATKINS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2008
-----------------------------------------------------
Last Update Date | 05/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 CREEKSTONE RDG STE 375
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-659-9168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1870
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30143-0110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 025308
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------