Provider Demographics
NPI:1750305058
Name:WATSON, NANCY M (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:676 HISTORIC HWY 441 NORTH
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-1718
Mailing Address - Country:US
Mailing Address - Phone:706-754-8884
Mailing Address - Fax:706-754-0160
Practice Address - Street 1:676 HISTORIC HWY 441 NORTH
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-8884
Practice Address - Fax:706-754-0160
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA042766OtherSTATE LICENSE
GA000718121AMedicaid
GA11BDLMTMedicare PIN
GA000718121AMedicaid