Provider Demographics
NPI:1821201161
Name:WATTS CHIROPRACTIC CLINIC P C
Entity Type:Organization
Organization Name:WATTS CHIROPRACTIC CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-886-7070
Mailing Address - Street 1:309 PIRKLE FERRY RD
Mailing Address - Street 2:E-100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2545
Mailing Address - Country:US
Mailing Address - Phone:770-886-7070
Mailing Address - Fax:770-886-6097
Practice Address - Street 1:309 PIRKLE FERRY RD
Practice Address - Street 2:E-100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2545
Practice Address - Country:US
Practice Address - Phone:770-886-7070
Practice Address - Fax:770-886-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU84327Medicare UPIN
GA35ZCDFTMedicare ID - Type Unspecified