Basic Information
| Provider Information | |||||||||
| NPI: | 1912967795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | JAYELYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850 | ||||||||
| Address2: | |||||||||
| City: | HURLEY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395550850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285882938 | ||||||||
| FaxNumber: | 2285889399 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 HWY 614 | ||||||||
| Address2: | |||||||||
| City: | HURLEY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285882938 | ||||||||
| FaxNumber: | 2285889399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101238363 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 21648 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010259037 | 05 | VA | MEDICAID |