Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | PHTC014532 | GA |
NPI | 1073109419 |
---|---|
Provider Name | Megan Chelisse Watson |
First Address | Savannah, GA 31405-9500 |
Second Address | Savannah, GA 31405-9500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2020 |
Last Update Date | 20/12/2020 |