Provider Demographics
NPI:1659934826
Name:WATSON, BRANDI TYSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:TYSON
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ALMOND RD
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-7367
Mailing Address - Country:US
Mailing Address - Phone:912-536-1882
Mailing Address - Fax:
Practice Address - Street 1:604 E LONG ST STE A
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-5914
Practice Address - Country:US
Practice Address - Phone:912-739-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139826208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery