Healthcare Provider Details

I. General information

NPI: 1932191657
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL WATSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HARPER STREET, BT-2641 CHILDREN'S HOSPITAL OF GEORGIA
AUGUSTA GA
30912
US

IV. Provider business mailing address

1446 HARPER STREET, BT-2641 CHILDREN'S HOSPITAL OF GEORGIA
AUGUSTA GA
30912
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4402
  • Fax:
Mailing address:
  • Phone: 706-721-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101236794
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0071105
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number075396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: