Provider Demographics
NPI:1689450611
Name:WATSON, NATANYAH (MBA HM, BS MLS)
Entity Type:Individual
Prefix:
First Name:NATANYAH
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MBA HM, BS MLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 CAIN COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3332
Mailing Address - Country:US
Mailing Address - Phone:631-575-8576
Mailing Address - Fax:
Practice Address - Street 1:2190 CAIN COMMONS DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3332
Practice Address - Country:US
Practice Address - Phone:631-575-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory