Individual
SAMUEL EDWARD WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
222 E MEDICAL LN STE 100&200, WEST COLUMBIA, SC 29169-4847
(803) 935-8410
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21129
SC
363LA2100X
Acute Care Nurse Practitioner
21129
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4752
—
SC
Enumeration date
07/24/2017
Last updated
12/20/2022
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