Provider Demographics
NPI:1437144748
Name:WATTS, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1839 E GARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4839
Mailing Address - Country:US
Mailing Address - Phone:704-864-2685
Mailing Address - Fax:704-864-9363
Practice Address - Street 1:1839 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4839
Practice Address - Country:US
Practice Address - Phone:704-864-2685
Practice Address - Fax:704-864-9363
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC38457208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986041Medicaid
NCF17437Medicare UPIN