Provider Demographics
NPI:1720421167
Name:RICHARD A WATSON, DC, PC
Entity Type:Organization
Organization Name:RICHARD A WATSON, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARVILLE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-641-0029
Mailing Address - Street 1:9570 NESBIT FERRY RD
Mailing Address - Street 2:ST. 101
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6859
Mailing Address - Country:US
Mailing Address - Phone:770-641-0029
Mailing Address - Fax:770-643-7845
Practice Address - Street 1:9570 NESBIT FERRY RD
Practice Address - Street 2:ST. 101
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6859
Practice Address - Country:US
Practice Address - Phone:770-641-0029
Practice Address - Fax:770-643-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002171111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97905Medicare UPIN