Provider Demographics
NPI:1790725893
Name:WATSON, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE E-487
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-697-0014
Mailing Address - Fax:423-648-6280
Practice Address - Street 1:2525 DESALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-697-0014
Practice Address - Fax:423-648-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39695207P00000X
TNMD034197207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3087582OtherBLUE CROSS
TN3856656Medicaid
TNP00325036OtherRAILROAD MEDICARE
KY64125180Medicaid
TNP00247851OtherRAILROAD MEDICARE
TN3856657Medicaid
TN4122496OtherBCBS OF TN
TNP00325036OtherRAILROAD MEDICARE
TNG66068Medicare UPIN
TN3087582OtherBLUE CROSS