Healthcare Provider Details

I. General information

NPI: 1427228261
Provider Name (Legal Business Name): EDWINA LOUISE WATSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax: 205-558-4715
Mailing address:
  • Phone: 205-933-8101
  • Fax: 205-558-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number14-74892-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: