Healthcare Provider Details

I. General information

NPI: 1568661767
Provider Name (Legal Business Name): TIMOTHEUS GEORGE WATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TOWER RD NE STE 204
MARIETTA GA
30060-9413
US

IV. Provider business mailing address

2835 BRANDYWINE RD SUITE 300
ATLANTA GA
30341-5510
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-2593
  • Fax: 770-488-9408
Mailing address:
  • Phone: 404-256-2593
  • Fax: 770-488-9408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57012642
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number069666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: