Provider Demographics
NPI:1063501757
Name:WATSON, ELIZABETH K (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3779
Mailing Address - Country:US
Mailing Address - Phone:912-466-5850
Mailing Address - Fax:912-912-4665
Practice Address - Street 1:3300 FOURTH ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3779
Practice Address - Country:US
Practice Address - Phone:912-466-5850
Practice Address - Fax:912-466-5881
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA105906343IMedicaid
GAQ17270Medicare UPIN
GA105906343CMedicaid