Provider Demographics
NPI:1659618379
Name:WATTS, SHENEETA MECHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHENEETA
Middle Name:MECHELLE
Last Name:WATTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHENEETA
Other - Middle Name:MECHELLE
Other - Last Name:TRAMMELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2330 SCENIC HWY S
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:678-632-1602
Mailing Address - Fax:
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2732
Practice Address - Country:US
Practice Address - Phone:860-347-6971
Practice Address - Fax:860-638-6831
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6770363A00000X
CT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty