Provider Demographics
NPI:1053549444
Name:WATSON, MARY CAROLYN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROLYN
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3361 SHADOWMOSS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5678
Mailing Address - Country:US
Mailing Address - Phone:850-815-0063
Mailing Address - Fax:
Practice Address - Street 1:608 DOGWOOD DR NE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:GA
Practice Address - Zip Code:31779-1132
Practice Address - Country:US
Practice Address - Phone:850-815-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126349207Q00000X
GA86385207Q00000X
FLTRN21015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine