Provider Demographics
NPI:1881034361
Name:WATSON, NICHOLE M (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3510 N HIGHWAY 17
Practice Address - Street 2:STE. 320
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8227
Practice Address - Country:US
Practice Address - Phone:843-971-3361
Practice Address - Fax:843-606-8003
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC38882207Q00000X
PAMT204523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine