MEDICARE: GARRISON GRIER WATTS JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	24555	SC

General Provider Information

NPI Number	:	1386813442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRISON GRIER WATTS JR. MD

Provider Business Mailing Address
First Line	:	127 E TRADE STREET
Second Line	:	STE B 100 COMMUNITY CLINIC RUTHERFORD CO
City	:	FOREST CITY
State	:	NC
Zip	:	28043-3131
Country	:	US
Telephone Number	:	828-245-0400
Fax Number	:	828-247-9000

Provider Business Practice Location Address
First Line	:	127 E TRADE STREET
Second Line	:	STE B 100 COMMUNITY CLINIC RUTHERFORD CO
City	:	FOREST CITY
State	:	NC
Zip	:	28043-3131
Country	:	US
Telephone Number	:	828-245-0400
Fax Number	:	828-247-9000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/28/2008

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