JERRY E WATSON (NPI# 1174519896) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174519896 |
| Entity Type | Individual |
| Full Name | JERRY E WATSON |
| Credential | MD |
| Practice Address |
920 Doug White Dr Ste 510 Myrtle Beach SC 29572-4120 |
| Practice Telephone | 8434977772 |
| Practice Fax Number | 8438487530 |
| Mailing Telephone | 8434977772 |
| Mailing Fax Number | 8438487530 |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2020-02-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
14980 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 149805 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073838439 | Jerry B Watson | Clinic/Center | 8324 La Camila Rd Ne, Albuquerque, NM 87110-2420 | 2010-03-29 |
| 1316902976 | Jerry Ray Watson | Orthopaedic Surgery | 250 Sundance Ct, Steamboat Springs, CO 80487-3058 | 2006-04-18 |
| 1962480293 | Jerry Franklin Watson | Surgery | 301 8th St, N Wilkesboro, NC 28659-4127 | 2006-01-06 |
| 1336759448 | Jerry Lee Watson IIi | Technician, Other | 1001 Laurence Ave, Jackson, MI 49202-2979 | 2020-08-04 |
| 1285273045 | Jerry Watson | Social Worker | 8566 Cordes Cir, Germantown, TN 38139-3317 | 2019-12-27 |
| 1225176456 | Jerry Watson | Social Worker | 45-691 Keaahala Rd, Kaneohe, HI 96744-3569 | 2007-02-01 |
| 1497771216 | Jerry Lynn Watson | Radiology | 3000 New Bern Ave, Raleigh, NC 27610-1231 | 2006-07-14 |
| Street Address |
920 DOUG WHITE DR STE 510 |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29572-4120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760478242 | Russell Frank Stahl | Specialist | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2005-09-21 |
| 1235761768 | Tara Katherine Bruno | Nurse Practitioner | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2020-02-12 |
| 1285142216 | Shannon Williamson Cribb | Nurse Practitioner | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2018-01-11 |
| 1629525225 | Robert Christian Dutlinger | Physician Assistant | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4183 | 2016-09-01 |
| 1063875474 | Tamiko Jackson | Nurse Practitioner | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2016-04-01 |
| 1932515558 | Shashikanth Nagabandi | Internal Medicine | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4183 | 2014-07-02 |
| 1023443231 | Morgan Overton Phillips | Physician Assistant | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2013-09-06 |
| 1043505092 | Katy Johnson | Physician Assistant | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2011-06-17 |
| 1710285051 | Heather Suzannah Cahoy | Physician Assistant | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2011-03-10 |
| 1063718807 | Ernest W Stokes IIi | Physician Assistant | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2011-01-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684576 | Matthew David Zeuschner | Nurse Practitioner | 107 Woodwind Court, Myrtle Beach, SC 29572 | 2020-09-16 |
| 1578191789 | Julia Ruth Nelson | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center- Gme Office, 809 82nd Parkway, Myrtle Beach, SC 29572 | 2020-04-01 |
| 1407484835 | Justin Schevers | Student in an Organized Health Care Education/Training Program | 802 82nd Parkway, Myrtle Beach, SC 29572 | 2020-03-31 |
| 1922636919 | Darian Michael Quigg | Student in an Organized Health Care Education/Training Program | 809 82nd Street Parkway, Myrtle Beach, SC 29572 | 2020-03-27 |
| 1881221141 | Jonathan Alden Bryan | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center, 809 82nd Parkway, Myrtle Beach, SC 29572 | 2020-03-26 |
| 1215575238 | Polaris Skin Diagnostics, LLC | Dermatology | 8170 Rourk Street, Suite 100, Myrtle Beach, SC 29572 | 2019-12-20 |
| 1700348711 | Five Star Rehabilitation and Wellness Services, LLC. | Clinic/Center | 9547 N Kings Hwy, Myrtle Beach, SC 29572 | 2019-04-01 |
| 1154882975 | Michael Kouandjio | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center-gme Office, 809 82nd Parkway, Myrtle Beach, SC 29572 | 2019-03-26 |
| 1154880102 | Dylan Chase Morgan | Internal Medicine | Grand Strand Medical Center - Gme Office, 809 82nd Pkwy, Myrtle Beach, SC 29572 | 2019-03-19 |
| 1710446828 | David Redding Kingery Jr. | Student in an Organized Health Care Education/Training Program | Gme Office 809 82nd Parkway, Myrtle Beach, SC 29572 | 2019-03-18 |
| Find all providers in zip 29572 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366461568 | Jimmy L Kontos | Internal Medicine | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2006-07-19 |
| 1194714279 | David Bowen Truluck | Internal Medicine | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2005-10-20 |
| 1528054244 | Mark P Karavan | Internal Medicine | 920 Doug White Dr Ste 510, Myrtle Beach, SC 29572-4120 | 2005-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003318080 | Cardiac Cin of South Carolina LLC | Internal Medicine | 6650 Rivers Ave Ste 405, North Charleston, SC 29406-4809 | 2018-03-06 |
| 1376834606 | Heart Associate of Hilton Head PC | Internal Medicine | 14 Westbury Park, Suite 103, Bluffton, SC 29910-7461 | 2011-04-20 |
| 1861485088 | Donald E Saunders IIi | Internal Medicine | 4969 Centre Pointe Dr, Suite 100, North Charleston, SC 29418-6952 | 2005-08-23 |
| 1568455723 | Scott L Woodfield | Internal Medicine | 1033 Saint Andrews Blvd, Charleston, SC 29407-7156 | 2005-08-23 |
| 1912400300 | Carolina Cardiology and Vascular Associates LLC | Internal Medicine | 3020 Sunset Blvd Ste 105, West Columbia, SC 29169-3494 | 2018-03-13 |
| 1851656482 | Vinod K Chaubey | Internal Medicine | 2376 Cypress Circle, Suite 102, Conway, SC 29526-8964 | 2012-07-10 |
| 1740569227 | Mohamed Faher Almahmoud | Internal Medicine | 169 Ashley Ave Rm 202, Charleston, SC 29425-0553 | 2011-08-15 |
| 1336439074 | Sebastiano Antonio Virgadamo | Internal Medicine | 1083 Boiling Springs Rd, Spartanburg, SC 29303-2248 | 2011-04-14 |
| 1104123835 | Heart Associate of Hilton Head LLC | Internal Medicine | 35 Hospital Center Cmns, Ste 101, Hilton Head, SC 29926-2845 | 2011-02-15 |
| 1740502822 | Bon Secours St Francis Xavier Hospital, Inc. | Internal Medicine | 2095 Henry Tecklenburg Dr, Charleston, SC 29414-5733 | 2010-02-17 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29572 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.