Provider Demographics
NPI:1225398811
Name:J. MICHAEL WATTS
Entity Type:Organization
Organization Name:J. MICHAEL WATTS
Other - Org Name:MARSHALL NEUROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-617-7088
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0030
Mailing Address - Country:US
Mailing Address - Phone:256-878-3999
Mailing Address - Fax:256-878-3779
Practice Address - Street 1:95 WALL ST
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7392
Practice Address - Country:US
Practice Address - Phone:256-878-3999
Practice Address - Fax:256-878-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X, 2084S0012X
ALDO.4492084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130002Medicaid
AL000045450Medicare PIN