Provider Demographics
NPI:1003415977
Name:SHADIX, CARSON WATSON (PA-C)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:WATSON
Last Name:SHADIX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARSON
Other - Middle Name:LEIGH
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5005 OSCAR BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3698
Mailing Address - Country:US
Mailing Address - Phone:205-343-2225
Mailing Address - Fax:205-343-7825
Practice Address - Street 1:5005 OSCAR BAXTER DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3698
Practice Address - Country:US
Practice Address - Phone:205-343-2225
Practice Address - Fax:205-343-7825
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1691363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant