Individual
JERRY E WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 DOUG WHITE DR STE 510, MYRTLE BEACH, SC 29572-4120
(843) 497-7772
(843) 848-7530
Mailing address
920 DOUG WHITE DR STE 510, MYRTLE BEACH, SC 29572-4120
(843) 497-7772
(843) 848-7530
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
14980
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149805
—
SC
Enumeration date
09/27/2005
Last updated
02/10/2020
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