Provider Demographics
NPI:1831171461
Name:WATSON, JOSHUA THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:THOMAS
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:STE 300
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3261
Mailing Address - Country:US
Mailing Address - Phone:843-884-5200
Mailing Address - Fax:843-884-6417
Practice Address - Street 1:1300 HOSPITAL DR
Practice Address - Street 2:STE 300
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3261
Practice Address - Country:US
Practice Address - Phone:843-884-5200
Practice Address - Fax:843-884-6417
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-4640207R00000X
GA69272207RG0100X, 208D00000X
SC37883207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA69272OtherSTATE LICENCE
SCMD37883OtherSC LICENSE
HIMDR-4640OtherHI LICENSE NUMBER
VAD000Medicare UPIN