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General NPI Number Information
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NPI Number | 1114402153
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Entity Type | Individual
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Provider Name | BROOKE ELIZABETH WATSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 5500 FRONT ST STE 260
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City | SUMMERVILLE
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State | SC
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Zip | 29486-8140
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Country | US
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Telephone | 843-576-0700
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Fax | 843-576-0701
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Provider Business Mailing Address
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Address Line | PO BOX 530062
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City | ATLANTA
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State | GA
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Zip | 30353-0062
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Country | US
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Telephone | 843-695-6071
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Fax | 843-569-5881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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