Provider Demographics
NPI:1942301759
Name:WATTS, RONALD STEVEN (MD, FACE)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEVEN
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9018
Mailing Address - Country:US
Mailing Address - Phone:770-389-9494
Mailing Address - Fax:770-357-2511
Practice Address - Street 1:1050 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9018
Practice Address - Country:US
Practice Address - Phone:770-389-9494
Practice Address - Fax:770-357-2511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044862174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000977523AMedicaid
GAH03433Medicare UPIN
GA000977523AMedicaid