Provider Demographics
NPI:1841425527
Name:WATTS, EDWARD JR (CSFA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:WATTS
Suffix:JR
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E SOUTH G ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-1752
Mailing Address - Country:US
Mailing Address - Phone:765-667-0020
Mailing Address - Fax:
Practice Address - Street 1:131 E SOUTH G ST
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-1752
Practice Address - Country:US
Practice Address - Phone:765-667-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-24
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist