# WILLIE MACK WATTS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1679772388
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 10853 | GA | Yes |
| 363AM0700X | Medical Physician Assistant | PA-184 | AL | — |

## Other

- **Enumeration date:** 07/12/2007
- **Last updated:** 06/13/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 009911802 | — | AL |