Provider Demographics
NPI:1134249675
Name:WATSON, BYRON MAURICE (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:MAURICE
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:204 SPRING ST
Mailing Address - Street 2:SUITE E & F
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1927
Mailing Address - Country:US
Mailing Address - Phone:478-746-9898
Mailing Address - Fax:478-746-9849
Practice Address - Street 1:204 SPRING ST
Practice Address - Street 2:SUITE E & F
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1927
Practice Address - Country:US
Practice Address - Phone:478-746-9898
Practice Address - Fax:478-746-9849
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0326732083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA032673OtherGEORGIA MEDICAL LICENSE
BW2212873OtherFEDERAL DEA
BW2212873OtherFEDERAL DEA