Organization Name: | CAPSTONE MEDICAL GROUP |
NPI Number: | 1689856981 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CLYDE WATKINS (PHYSICIAN) |
Mailing Address: | 5900 Hillandale Dr Annex E Lithonia |
State: | GA US |
Postal Code: | 300583802 |
Phone Number: | 4044463870 |
Fax Number: | 4044463875 |
NPI Enumeration Date: | 11/29/2007 |
NPI Last Update Date: | 11/29/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 036033 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |