Provider Demographics
NPI:1962091512
Name:WATSON, JOURDAIN DAVIS (FNP-C)
Entity type:Individual
Prefix:
First Name:JOURDAIN
Middle Name:DAVIS
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 EMANUEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7309
Mailing Address - Country:US
Mailing Address - Phone:912-242-2302
Mailing Address - Fax:
Practice Address - Street 1:406 UNION ST
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-4230
Practice Address - Country:US
Practice Address - Phone:912-242-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty