Provider Demographics
NPI:1235401043
Name:WATSON ADVANCED CARE, LLC
Entity Type:Organization
Organization Name:WATSON ADVANCED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:901-233-2667
Mailing Address - Street 1:PO BOX 42013
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-2013
Mailing Address - Country:US
Mailing Address - Phone:901-233-2667
Mailing Address - Fax:901-276-2357
Practice Address - Street 1:3445 POPLAR AVE STE 13
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4667
Practice Address - Country:US
Practice Address - Phone:901-233-2667
Practice Address - Fax:901-276-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty