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General NPI Number Information
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NPI Number | 1285959478
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Entity Type | Individual
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Provider Name | GREG G WATTERSON LMT
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Gender | Male
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 3521 MACLAY BLVD S
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3913
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Country | US
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Telephone | 850-431-2348
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 STURBRIDGE PL
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7907
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Country | US
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Telephone | 850-212-4688
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | MA 53580
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License Number State | FL
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