Provider Demographics
NPI:1083494314
Name:WATSON, MATTHEW JAVED (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAVED
Last Name:WATSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 VININGS RETREAT VW SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2574
Mailing Address - Country:US
Mailing Address - Phone:954-470-6732
Mailing Address - Fax:
Practice Address - Street 1:5015 FLOYD RD SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1673
Practice Address - Country:US
Practice Address - Phone:770-819-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist