Individual
DR. SHANNON K WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 399-6727
(304) 399-6726
Mailing address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 399-6727
(304) 399-6726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22286
WV
208M00000X
Hospitalist Physician
22286
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184838906
—
WV
05
—
2795201
—
OH
01
—
3810011352
MEDICAID
WV
05
—
7100036310
—
KY
01
—
P00628003
MEDICARE RR
WV
Enumeration date
05/10/2007
Last updated
08/24/2022
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