MEDICARE: MR. JOHN WATKINS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT001795	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10755362	OTHER		CAQH #

General Provider Information

NPI Number	:	1780770628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WATKINS PT

Provider Business Mailing Address
First Line	:	1765 OLD WEST BROAD ST BLDG 2-200
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2887
Country	:	US
Telephone Number	:	706-549-1663
Fax Number	:	706-546-8792

Provider Business Practice Location Address
First Line	:	1553 JANMAR RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-5606
Country	:	US
Telephone Number	:	770-554-5009
Fax Number	:	706-546-8792

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	03/11/2024

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Directions to “ MR. JOHN WATKINS PT” Practice Location

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