Provider Demographics
NPI:1225803877
Name:WATTS, JUSTIN RAY
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RAY
Last Name:WATTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1547
Mailing Address - Country:US
Mailing Address - Phone:606-568-9309
Mailing Address - Fax:
Practice Address - Street 1:361 OLD WAGNER STATION RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2925
Practice Address - Country:US
Practice Address - Phone:606-471-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty