Active NPI
Stephanie Hickman Watson, PHARMD
- Pharmacist
- Waycross, GA
National Provider Identifier
1124779632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 020455
- Practice address
- 1919 Alice St
Waycross, GA 31501-6207 - Phone
- (912) 283-5504
- Fax
- (912) 283-0880
- NPI assigned
- Jan 17, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 020455 | GA | Primary |
Addresses
Primary practice location
1919 Alice St
Waycross, GA 31501-6207
Mailing address
1307 City Blvd
Waycross, GA 31501-4246
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020455 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642377600000",
"number": "1124779632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1307 CITY BLVD",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315014246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 ALICE ST",
"city": "WAYCROSS",
"state": "GA",
"postal_code": "315016207",
"telephone_number": "912-283-5504",
"fax_number": "912-283-0880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "STEPHANIE",
"middle_name": "HICKMAN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-17",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "020455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waycross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.