Provider Demographics
NPI:1083171326
Name:WATTS, JASON EDWARD (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:EDWARD
Last Name:WATTS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SHORTER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4268
Mailing Address - Country:US
Mailing Address - Phone:706-235-5722
Mailing Address - Fax:
Practice Address - Street 1:314 SHORTER AVE NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4268
Practice Address - Country:US
Practice Address - Phone:706-235-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219889363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty