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General NPI Number Information
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NPI Number | 1093475824
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Entity Type | Organization
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Legal Business Name | MARY CAROLYN WATSON
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 608 DOGWOOD DR NE
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City | PELHAM
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State | GA
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Zip | 31779-1132
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Country | US
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Telephone | 850-815-0063
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Fax |
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Provider Business Mailing Address
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Address Line | 3361 SHADOWMOSS DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5678
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY WATSON
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Credential | MD
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Telephone | 850-815-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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