Provider Demographics
NPI:1639358864
Name:WATTS, SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-1464
Mailing Address - Country:US
Mailing Address - Phone:334-443-0160
Mailing Address - Fax:334-443-0162
Practice Address - Street 1:2126 W ROY PARKER RD # 207
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-8566
Practice Address - Country:US
Practice Address - Phone:334-443-0160
Practice Address - Fax:334-443-0162
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery