Basic Information
| Provider Information | |||||||||
| NPI: | 1518070531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATTS | ||||||||
| FirstName: | SYLVIA | ||||||||
| MiddleName: | MCKOY | ||||||||
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| OtherLastName: | MCKOY | ||||||||
| OtherFirstName: | SYLVIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1090 | ||||||||
| Address2: | |||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295511090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438570111 | ||||||||
| FaxNumber: | 8438570206 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MC COLL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295702020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435235751 | ||||||||
| FaxNumber: | 8435236040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1392 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP0658 | 05 | SC | MEDICAID | P00906547 | 01 | SC | RAILROAD MEDICARE PTAN | OTHER |