=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871885079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST LITTLE ROCK WOMENS CENTER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2011
-----------------------------------------------------
Last Update Date | 10/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12921 CANTRELL RD SUITE 300
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-907-6699
-----------------------------------------------------
Fax | 501-224-6481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12921 CANTRELL RD SUITE 300
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72223-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-907-6699
-----------------------------------------------------
Fax | 501-224-6481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. JULIA MORTIMER WATKINS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 501-907-6699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------