Provider Demographics
NPI:1699178293
Name:CASAL, DEVARRA WATSON (MD)
Entity Type:Individual
Prefix:
First Name:DEVARRA
Middle Name:WATSON
Last Name:CASAL
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 421158
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-8158
Mailing Address - Country:US
Mailing Address - Phone:404-565-0247
Mailing Address - Fax:
Practice Address - Street 1:215 POWERS CV
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3405
Practice Address - Country:US
Practice Address - Phone:404-565-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040341208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics