Provider Demographics
NPI:1265698559
Name:WATSON, AMANDA W (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:W
Last Name:WATSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:W
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1210 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9272
Mailing Address - Country:US
Mailing Address - Phone:706-322-1717
Mailing Address - Fax:706-322-1718
Practice Address - Street 1:1210 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9272
Practice Address - Country:US
Practice Address - Phone:706-322-1717
Practice Address - Fax:706-322-1718
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5328363A00000X
VA0110002862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical