Organization
JAACA MANAGEMENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANFORD E WATKINS MD (OWNER)
(903) 521-9861
Entity
Organization
Contact information
Practice address
5505 NEW COPELAND RD, TYLER, TX 75703-3955
(903) 521-9861
Mailing address
PO BOX 6008, TYLER, TX 75711-6008
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3109
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992781090
INDIVIDUAL NPI
TX
Enumeration date
09/20/2013
Last updated
09/20/2013
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