Provider Demographics
NPI:1639749443
Name:WATTS, MICHELLE TAYLOR (PA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TAYLOR
Last Name:WATTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MURFREESBORO HWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3206
Mailing Address - Country:US
Mailing Address - Phone:931-728-5607
Mailing Address - Fax:
Practice Address - Street 1:2345 MURFREESBORO HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3206
Practice Address - Country:US
Practice Address - Phone:931-728-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program