Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 029118 | GA |
Y | 111NI0900X | Internist | 029118 | GA |
N | 207RG0300X | Geriatric Medicine | 029118 | GA |
NPI | 1124027842 |
---|---|
Provider Name | Dr. Benjamin Luther Watson |
First Address | Savannah, GA 31406-3928 |
Second Address | Savannah, GA 31406-3928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 04/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000374437F | (05) | GA |
681683 | BCBS (01) | GA |
D41338 | (02) | |
G29118 | (05) | SC |