Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 30196 | SC |
NPI | 1114139854 |
---|---|
Provider Name | Dr. Erin Watson |
First Address | Conway, SC 29526-8964 |
Second Address | Conway, SC 29526-8964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 20/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA22603850 | (02) | SC |