Provider Demographics
NPI:1205281300
Name:WATSON, AMIRACLE SHA'RON
Entity type:Individual
Prefix:
First Name:AMIRACLE
Middle Name:SHA'RON
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 MCGINNIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8315
Mailing Address - Country:US
Mailing Address - Phone:678-327-0989
Mailing Address - Fax:
Practice Address - Street 1:4025 MCGINNIS FERRY RD
Practice Address - Street 2:APT 1327B
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8315
Practice Address - Country:US
Practice Address - Phone:678-327-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health