Provider Demographics
NPI:1033119474
Name:WATSON, ANDREW T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 KATE BOND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4062
Mailing Address - Country:US
Mailing Address - Phone:901-300-2971
Mailing Address - Fax:901-384-8988
Practice Address - Street 1:2996 KATE BOND RD STE 105
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4062
Practice Address - Country:US
Practice Address - Phone:901-300-2971
Practice Address - Fax:901-384-8988
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI28802Medicare UPIN