Provider Demographics
NPI:1225183163
Name:WATSON, PAMELA P (NP C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:P
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 JOHNS CREEK PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-957-1910
Mailing Address - Fax:678-957-1911
Practice Address - Street 1:4365 JOHNS CREEK PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-957-1910
Practice Address - Fax:678-957-1911
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBHZGMedicare ID - Type Unspecified
S86530Medicare UPIN