MEDICARE: SHAWNA LEE WATSON M.D.

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	207X00000X	Orthopaedic Surgery Physician	34428	FL
2	207X00000X	Orthopaedic Surgery Physician	97499	GA

General Provider Information

NPI Number	:	1073046876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA LEE WATSON M.D.

Provider Business Mailing Address
First Line	:	20 GLENLAKE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3473
Country	:	US
Telephone Number	:	470-698-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 GLENLAKE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3473
Country	:	US
Telephone Number	:	470-698-6488
Fax Number	:

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

Provider Enumeration Date	:	04/07/2017
Last Update Date	:	09/04/2024

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