CICELY ANNETTE WATSON
Complete NPI Record 1255894366
Physical Therapist - Pediatrics in Duluth, GA
Active since April 08, 2019
Complete NPI Dataset
This page contains the complete raw NPPES record for Cicely Annette Watson (NPI 1255894366), an individual physical therapist provider in Duluth, GA. All 25 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1255894366 Field 1/25
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/25
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: WATSON Field 3/25
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: CICELY Field 4/25
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: ANNETTE Field 5/25
- The middle name of the provider, if the provider is an individual.
- Provider First Line Business Mailing Address: 3508 CASTLEHILL CT Field 6/25
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: TUCKER Field 7/25
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: GA Field 8/25
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 300843201 Field 9/25
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 10/25
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 6787797806 Field 11/25
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 2620 SATELLITE BLVD STE 100 Field 12/25
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: DULUTH Field 13/25
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: GA Field 14/25
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 300961291 Field 15/25
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/25
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4047858619 Field 17/25
- The telephone number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 20/25
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 2251P0200X Field 21/25
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: PT007774 Field 22/25
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: GA Field 23/25
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 24/25
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 25/25
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
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