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General NPI Number Information
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NPI Number | 1215625181
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Entity Type | Individual
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Provider Name | ALICIA LAVETTE WATSON NP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 3651 WHEELER RD
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City | AUGUSTA
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State | GA
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Zip | 30909-6426
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Country | US
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Telephone | 706-651-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 2843 MANDY CT
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City | JONESBORO
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State | GA
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Zip | 30236-4187
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Country | US
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Telephone | 229-375-4886
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN259656
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License Number State | GA
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