Provider Demographics
NPI:1760822795
Name:WATSON, NICHOLAS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EDWARD
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NIC
Other - Middle Name:EDWARD
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2986 KATE BOND RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4003
Mailing Address - Country:US
Mailing Address - Phone:901-820-7750
Mailing Address - Fax:901-820-7751
Practice Address - Street 1:2986 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4003
Practice Address - Country:US
Practice Address - Phone:901-820-7750
Practice Address - Fax:901-820-7751
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57002207P00000X
IL036139973207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine