Individual
TANGELA S. WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
706 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2366
(601) 990-2513
(601) 990-2526
Mailing address
PO BOX 984, FAYETTE, MS 39069-0984
(601) 532-0245
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
801415495
DRIVER'S LICENSE
MS
Enumeration date
05/17/2019
Last updated
05/17/2019
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