Provider Demographics
NPI:1811427289
Name:WATSON, HEBER J III (DO)
Entity type:Individual
Prefix:
First Name:HEBER
Middle Name:J
Last Name:WATSON
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:6010 HIGHWAY 707 STE 100
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7321
Practice Address - Country:US
Practice Address - Phone:843-234-8939
Practice Address - Fax:843-234-8959
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2025-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC40723207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC407233Medicaid