Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 428574-00 | GA |
N | 175L00000X | Homeopath | MT005235 | GA |
Y | 225700000X | Massage Therapist | MT005235 | GA |
NPI | 1538562764 |
---|---|
Provider Name | Elaine Watson |
First Address | Waycross, GA 31501-4724 |
Second Address | Waycross, GA 31501-4724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2014 |
Last Update Date | 08/10/2014 |