Individual
CHARLES EARL WATTS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2412 N OAK ST, VALDOSTA, GA 31602-2567
(229) 244-1400
(229) 244-5512
Mailing address
2412 N OAK ST, VALDOSTA, GA 31602-2567
(229) 244-1400
(229) 244-5512
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
6922
GA
363A00000X
Physician Assistant
Primary
7884
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I971838
MEDICARE PROVICE PTAN
GA
Enumeration date
01/27/2016
Last updated
02/15/2016
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