Healthcare Provider Details

I. General information

NPI: 1932358314
Provider Name (Legal Business Name): MISS MAISHA E WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 ALICE AVE
MEMPHIS TN
38106-6543
US

IV. Provider business mailing address

1087 ALICE AVE
MEMPHIS TN
38106-6543
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-5841
  • Fax: 901-821-5615
Mailing address:
  • Phone: 901-821-5841
  • Fax: 901-821-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: