Individual
MS. VIVIAN E WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
612 LOVE AVE, TIFTON, GA 31794
(229) 391-3300
(229) 388-1948
Mailing address
612 LOVE AVE, TIFTON, GA 31794
(229) 391-3300
(229) 388-1948
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN050405NP
GA
363LF0000X
Family Nurse Practitioner
RN050405 NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003124296A
—
GA
Enumeration date
10/07/2009
Last updated
05/07/2015
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