Provider Demographics
NPI:1326197740
Name:WATSON, BLYTHE J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BLYTHE
Middle Name:J
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:811 13TH ST STE 20
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2771
Mailing Address - Country:US
Mailing Address - Phone:706-722-3401
Mailing Address - Fax:706-724-6540
Practice Address - Street 1:811 13TH ST STE 20
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2771
Practice Address - Country:US
Practice Address - Phone:706-722-3401
Practice Address - Fax:706-724-6540
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0005551363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical