Provider Demographics
NPI:1386043826
Name:WATSON, EBONI
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 MANCHESTER EXPY STE A13-14
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6444
Mailing Address - Country:US
Mailing Address - Phone:706-653-9343
Mailing Address - Fax:
Practice Address - Street 1:506 MANCHESTER EXPY STE A13-14
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6444
Practice Address - Country:US
Practice Address - Phone:706-653-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services