Healthcare Provider Details

I. General information

NPI: 1861264913
Provider Name (Legal Business Name): EMILY MICHELE WATSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ELMO DR
CROSSVILLE TN
38555-4807
US

IV. Provider business mailing address

1441 SPRING POINTE LN
COOKEVILLE TN
38506-6043
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-5525
  • Fax:
Mailing address:
  • Phone: 615-516-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: