MEDICARE: TAMMY G WATTS ANP

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	363LA2200X	Adult Health Nurse Practitioner	455	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992745905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY G WATTS ANP

Provider Business Mailing Address
First Line	:	3710 LANDMARK DR
Second Line	:	STE 114
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4034
Country	:	US
Telephone Number	:	803-851-5966
Fax Number	:	803-828-4618

Provider Business Practice Location Address
First Line	:	3710 LANDMARK DR
Second Line	:	STE 114
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4034
Country	:	US
Telephone Number	:	803-788-5916
Fax Number	:	803-788-9564

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/18/2018

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