Provider Demographics
NPI:1588398564
Name:WATKINS, JADA UNIQUE (PN)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:UNIQUE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COMMERCIAL CT STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3671
Mailing Address - Country:US
Mailing Address - Phone:912-352-4357
Mailing Address - Fax:912-352-4395
Practice Address - Street 1:600 COMMERCIAL CT STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3671
Practice Address - Country:US
Practice Address - Phone:912-352-4357
Practice Address - Fax:912-352-4395
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5241616164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse