Individual
DR. BRIAN WESLEY WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 692-1495
(843) 449-6213
Mailing address
PO BOX 741087, ATLANTA, GA 30374-1087
(843) 847-4179
(843) 847-4296
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
0101241191
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
079408
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
41084
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144352428
—
VA
05
—
3810011003
—
WV
01
—
P00417627
RAILROAD MEDICARE
—
Enumeration date
03/12/2007
Last updated
11/02/2019
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