NPIMap

Individual provider Active NPI

Raquel Maria Watson, M.D.

  • Family Medicine Physician
  • Stone Mountain, GA
National Provider Identifier
1215936323
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
032674 Issued in GA
Practice address
5300 Memorial Dr Ste 121
Stone Mountain, GA 30083-3154
Phone
(404) 254-4500
Fax
(404) 254-4517
NPI assigned
Jul 20, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QA0401X 032674 GA
Family Medicine Physician 207Q00000X 032674 GA Primary

Addresses

Primary practice location

5300 Memorial Dr Ste 121
Stone Mountain, GA 30083-3154

Mailing address

142 Waters Edge Dr
Lizella, GA 31052-3629
Phone (478) 744-9920

Other practice location 1

3000 Schatulga Rd
Columbus, GA 31907-3117
Phone (706) 568-5000

Other identifiers 1

IdentifierTypeStateIssuer
000449721SMedicaidGA

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)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Fulton County Mental Health Center Past Accepting new patients
Fulton County Mhddad Past Accepting new patients
Georgia Department of Human Resources Single Specialty Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1215936323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 WATERS EDGE DR",
            "city": "LIZELLA",
            "state": "GA",
            "postal_code": "310523629",
            "telephone_number": "478-744-9920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 MEMORIAL DR STE 121",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833154",
            "telephone_number": "404-254-4500",
            "fax_number": "404-254-4517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Schatulga Rd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "GA",
            "postal_code": "319073117",
            "country_code": "US",
            "telephone_number": "706-568-5000",
            "fax_number": "706-568-5339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "RAQUEL",
        "middle_name": "MARIA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "GA",
            "license": "032674",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "032674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000449721S",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.