Individual
WILLIE MACK WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4292 GRAY HWY, GRAY, GA 31032-5900
(478) 986-2500
(478) 864-1288
Mailing address
PO BOX 73, PORT ROYAL, SC 29935-0073
(256) 393-9663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10853
GA
363AM0700X
Medical Physician Assistant
PA-184
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009911802
—
AL
Enumeration date
07/12/2007
Last updated
06/13/2022
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