Basic Information
| Provider Information | |||||||||
| NPI: | 1497732929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 KNOB CREEK RD STE 16 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239750764 | ||||||||
| FaxNumber: | 4239750141 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 KNOB CREEK RD STE 16 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239750764 | ||||||||
| FaxNumber: | 4239750141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 04/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD0000019488 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q004812 | 05 | TN | MEDICAID |