Individual
KANDRA W WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
610 19TH ST, COLUMBUS, GA 31901-1528
(706) 332-7884
(706) 243-4356
Mailing address
P O BOX 84052, COLUMBUS, GA 31908-4052
(706) 332-7884
(706) 243-4358
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
064988
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000310384A
—
GA
05
—
000310384C
—
GA
05
—
003101384B
—
GA
01
—
600-62186
BCBSAL
GA
Enumeration date
08/18/2006
Last updated
03/01/2012
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