Individual
TEQUASIA WATTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
508 GASKIN AVE S, DOUGLAS, GA 31533-1806
(912) 292-8722
Mailing address
400 ROCKBOROUGH TER, STONE MOUNTAIN, GA 30083-3848
(678) 637-9984
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
034-R-2040
GA
Other
Enumeration date
04/13/2021
Last updated
04/13/2021
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