Provider Demographics
NPI:1801282892
Name:GREEN-WATSON, DANIELLE MATRECE (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MATRECE
Last Name:GREEN-WATSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3387 HIGHWAY 5 STE H
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6900
Mailing Address - Country:US
Mailing Address - Phone:407-844-4499
Mailing Address - Fax:770-741-0775
Practice Address - Street 1:3387 HIGHWAY 5 STE H
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6900
Practice Address - Country:US
Practice Address - Phone:404-217-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01573213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery